Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time.
BACKGROUND
In tropical sprue (TS), response to antibiotics may suggest a role for bacterial contamination of the small bowel, which is known in diseases with prolonged orocecal transit time (OCTT).


METHODS
We studied 13 patients with TS (diagnosed by standard criteria) for frequency, nature and degree of bacterial contamination of the small bowel by quantitative culture of jejunal aspirate, glucose hydrogen breath test (GHBT), and OCTT by lactulose hydrogen breath test before and after treatment. Twelve patients with constipation-predominant irritable bowel syndrome (IBS) and 12 healthy subjects served as controls.


RESULTS
Ten of 13 patients with TS had bacterial contamination compared with 3/12 with IBS (all aerobic, P < 0.05). Median colony count in TS (36 000 CFU/mL, 400 to > 100 000) was higher than IBS (700 CFU/mL, 100-1000, P < 0.05). Gram-negative aerobic bacilli were commonly isolated in TS but not in IBS. Median OCTT was longer in TS (180 m, 40 - 240) than IBS (110 m, 70 - 150, P = 0.008) and healthy subjects (65 m, 40 - 110, P = 0.0007, Wilcoxon rank sum test). Orocecal transit time in TS correlated with fecal fat (Spearman's rank correlation coefficient 0.69, P < 0.05). Orocecal transit time and fecal fat, repeated in 8/13 patients, decreased with treatment for TS (195 m, 130-240 vs 125 m, 90-200, P = 0.02; 8 g/24 h, 6.8-19.6 vs 7 g/24 h, 4.2-9, P = 0.04, respectively).


CONCLUSIONS
Aerobic bacterial contamination of the small bowel is common in patients with TS. Prolonged OCTT in TS correlated with fecal fat and normalized in a subset of patients after treatment.
Ghoshal
Uday C
UC
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ghoshal@sgpgi.ac.in
Ghoshal
Ujjala
U
Ayyagari
Archana
A
Ranjan
Piyush
P
Krishnani
Narendra
N
Misra
Asha
A
Aggarwal
Rakesh
R
Naik
Sita
S
Naik
Subhash R
SR
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001420:Bacteria, Aerobic / Q000502:physiology*; D001944:Breath Tests / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005772:Gastrointestinal Transit; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology* / Q000473:pathology; D007583:Jejunum / Q000382:microbiology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D013182:Sprue, Tropical / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D013752:Tetracycline / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D006397:Hematinics; D005492:Folic Acid; D013752:Tetracycline