Bacteria of the gastric antrum and their relation to chronic gastritis.

Biopsy samples from the gastric antrum were taken from 61 patients. On bacteriological culture, Campylobacter pylori was isolated in 27 subjects. Thirty-four patients had chronic gastritis, as seen in routine-stained histological sections. By means of the May-Grünwald-Giemsa (MGG) staining technique, bacteria were demonstrated in sections from 26 subjects. Of these, 22 had gastritis histologically. In 13 subjects, structures similar to Campylobacter pylori were found in MGG-stained sections, 11 of these having chronic active gastritis histologically. Scanning electron microscopy demonstrated bacteria with the typical appearance of Campylobacter pylori, but other types of bacteria were also found, both on electron microscopy and on bacteriological culture. The study confirms that there is an increased frequency of histological gastritis when Campylobacter pylori is present in the samples (p = 0.009). However, a causative role of the bacteria could not be demonstrated in this study, and bacterial penetration into the epithelium was not observed.

Assessment of Mucosal Inflammation and Circulation in Response to Probiotics in Patients Operated with Ileal Pouch Anal Anastomosis for Ulcerative Colitis.

BACKGROUND: Pouchitis is a common and troublesome condition, and a disturbed microbiological flora and mucosal blood flow in the pouch have been suggested as possible causes. Laser Doppler flowmetry (LDF) has been used successfully to measure gastric and colonic mucosal perfusion in humans. The aim of this study was to evaluate the effect of intervention with probiotics on ileal pouch inflammation and perfusion in the pouch, assessed by endoscopy, histology, fecal calprotectin and LDF. METHODS: A fermented milk product (Cultura; 500 ml) containing live lactobacilli (La-5) and bifidobacteria (Bb-12) was given daily for 4 weeks to 10 patients operated with ileal-pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Mucosal perfusion was measured with LDF and the degree of inflammation was examined at predefined levels of the distal bowel by endoscopy and histology. Stool samples were cultured for lactobacilli and bifidobacteria and calprotectin were measured before and after intervention. RESULTS: The LDF measurements were reproducible in the pelvic pouch at each of the predefined levels, but did not change after intervention. The mucosal perfusion was reduced in the distal compared to the proximal part of the pouch. Calprotectin levels did not change significantly after intervention. The median endoscopic score for inflammation was significantly reduced by 50% after intervention, whereas the histological score did not change significantly. CONCLUSION: The results suggest that probiotics primarily act superficially, with change of gross appearance of the mucosa at endoscopy, but without significant effect on histological picture, mucosal perfusion or faecal calprotectin, during a relatively short period of 4 weeks.

Small bowel bacterial overgrowth syndrome.

Different aspects of the small bowel bacterial overgrowth syndrome are reviewed. Special emphasis is put on the newly recognized structural and functional abnormalities of the small intestinal mucosa, abnormalities that may not be fully reversed by effective antimicrobic therapy. The pathogenetic mechanisms involved in the malabsorption of different substances are discussed and the available diagnostic tests are briefly presented. The current therapy, surgical, medical and supportive, are outlined. It is pointed out that abnormal overgrowth flora of the small intestine can occur unassociated with malabsorption. Thus, the clinician must assess the potential benefit to be derived from treatment, once the presence of absorptive abnormalities is documented.

Bacterial overgrowth.

Different aspects of bacterial overgrowth in the small intestine are reviewed. The pathophysiological mechanisms involving both bacterial metabolism of dietary components and secretions and effects on the mucosal cells are discussed in more detail. The current therapy, surgical, medical and supportive, is outlined.

Outcome of four weeks' intervention with probiotics on symptoms and endoscopic appearance after surgical reconstruction with a J-configurated ileal-pouch-anal-anastomosis in ulcerative colitis.

OBJECTIVE: Pouchitis is a common and troublesome condition in patients operated on with ileal-pouch-anal-anastomosis (IPAA). A disturbed microecology in the pouch has been suggested as one possible explanation. In a previous double-blind, randomized, controlled study we demonstrated clinical improvement of symptoms in patients with ulcerative colitis (UC) operated on with IPAA, during intervention with live probiotic microbes Lactobacilli and Bifidobacteriae. The aim of the present study was to confirm our previous results in a much larger material, including clinical symptoms, faecal flora and endoscopic evaluation, and to compare the results in UC/IPAA patients with those of patients with familial adenomatous polyposis (FAP) with IPAA and UC patients with ileorectal anastomosis (IRA). MATERIAL AND METHODS: Five hundred millilitres of a fermented milk product (Cultura) containing live lactobacilli (La-5) and bifidobacteriae (Bb-12) was given daily for 4 weeks to 51 UC patients and 10 patients with FAP, operated on with IPAA, and six UC patients operated on for IRA. Stool samples were cultured for examination of lactobacilli, bifidobacteriae, fungi and pH before, during and after intervention. Before, during and after intervention, endoscopic evaluation was performed. Categorized symptomatology was examined prospectively using diary cards in addition to an interview, before and on the last day of intervention. RESULTS: The number of lactobacilli and bifidobacteriae increased significantly during intervention in the UC patients operated on with IPAA and remained significantly increased one week after intervention. Involuntary defecation, leakage, abdominal cramps and the need for napkins (category I), faecal number and consistency (category II) and mucus and urge to evacuate stools (category III) were significantly decreased during intervention in the UC/IPAA group. In the FAP group there was a significant decrease in faecal leakage, abdominal cramps and use of napkins (category I) during intervention. The median endoscopic score of inflammation was significantly decreased during intervention in the UC/IPAA patients. Blood tests, faecal fungi and faecal pH did not change significantly during intervention. CONCLUSIONS: Results of this extended study, showing an effect of probiotics on symptoms and endoscopic inflammation in UC patients operated on with IPAA confirm our previously reported effect of probiotics on clinical symptoms and endoscopic score in a smaller, double-blind, randomized, controlled study. The significantly higher response to probiotics in families with increased risk of IBD will have to be repeated in future studies.

Measurement of pulmonary hydrogen (H2) and H2 diffusion from the small bowel and the colon.

An accurate, relatively simple gas-solid chromatographic method for determination of breath H2 is described. Three different end-expiratory breath sampling techniques were evaluated. Changes in ventilatory activity was found to be the main cause of inaccuracies in end-expiratory breath H2 determinations. Pulmonary H2 excretion was measured after instillations of H2 in jejunum and colon. H2 excretion during the first 30 min after instillation was approximately seven times greater from the jejunum than from the colon. Marked individual variability was noted, and it is suggested that this may be explained by variations in intestinal peristaltic activity, which must be of importance in the process of H2 diffusion from gut lumen. It is further suggested that the H2 breath test should be regarded as a semi-quantitative test for intestinal H2 formation.

Relationships between hydrogen (H2) and methane (CH4) production in man.

The H2 breath test was performed by ingestion of 33 g lactulose and analysis of end-expiratory air. Eight of 100 healthy subjects failed to produce significant amounts of H2. The test was repeated twice in these eight subjects. Four had a flat excretion curve in all three tests, and all excreted large amounts of breath CH4. Of the 100, 34 had breath CH4 above 0.5 mumol/l. They had significantly lower fasting breath H2 and breath H2 excretion after lactulose than the 66 with breath CH4 below 0.5 mumol/l (p less than 0.01). By means of a gas chromatographic method with high sensitivity for CH4, 33 of the 100 subjects were restudied with parallel measurement of pulmonary excretion of H2 and CH4. Typical patterns of excretion were found in the subjects with endogenous CH4 production, showing either high excretion of H2 and low CH4 or low H2 and high CH4. A combination of high H2 and high CH4 was never seen. These findings suggest that CH4 is produced in the human intestine chiefly by an H2-utilizing flora and that adequate assessment of gut bacterial carbohydrate fermentation would require parallel measurement of breath H2 and CH4. The prevalence of CH4 production in a group of 120 healthy subjects, determined by a single midday breath sample, was 44%, with no significant difference between sexes and no correlation to age. Repeated midday breath sampling in 12 subjects during 1 month proved this method to be very reliable in the assessment of an individual's ability to produce CH4.

Influence of three antimicrobial agents--penicillin, metronidazole, and doxycyclin--on the intestinal microflora of healthy humans.

Antimicrobial drugs may affect the normal gut microflora in a potentially harmful manner. The purpose of the present study was to ascertain whether any of several tests could detect drug influence on the intestinal flora of healthy subjects. Jejunal secretions and feces were cultivated aerobically and anaerobically, with measurement of fermentation gas production in tubes supplemented with glucose or lactulose; bacterial bile acid deconjugation was measured with the 14C-GCA test; and pulmonary H2 and CH4 excretion were measured with gas-solid chromatography after lactulose and glucose ingestion in 18 healthy subjects before and after peroral treatment with either penicillin, metronidazole, or doxycyclin. Bacterial numbers and fermentation gas production were unchanged after treatment, as was the bacterial bile acid deconjugating activity. Pulmonary H2 excretion after lactulose ingestion was significantly reduced after penicillin and metronidazole but not after doxycyclin treatment. Pulmonary CH4 disappeared after metronidazole but remained unchanged after penicillin and doxycyclin treatment. It is concluded that pulmonary H2 and CH4 measurement after lactulose ingestion may serve as a sensitive determinant for drug effects on the normal gut microflora.

Short-chain fatty acids and bowel functions in man.

The fecal excretion of short-chain fatty acids (SCFAs) (measured by gas chromatography), transit time (assayed by radiopaque plastic markers), fecal weight, intake of dietary fiber, and their relationship have been studied in 10 healthy subjects during 1 week. The subjects had a fiber intake (mean +/- SD) of 26.3 +/- 7.9 g/day, a fecal weight of 160 +/- 49 g/day, and an average transit time of 41 +/- 9 h and excreted 11.1 +/- 5.5 mmol of SCFAs/day, with a concentration of 66.7 +/- 28.0 mmol/kg feces. The mean amount of SCFAs, but not their concentration, correlated to mean fecal weight (p less than 0.01) and mean transit time (p less than 0.01). The mean fecal weight correlated to mean transit time (p less than 0.05). The mean intake of dietary fiber did not correlate to any of the other variables. The results of this study indicate that other substrates are more important than fiber for the bacterial formation of SCFAs in the colon. The SCFAs formed most likely do not exert any direct laxative effect.

Relative value of sternal aspiration, iliac crest biopsy and biopsy imprint in the diagnosis of secondary cancer involvement of the bone marrow.

Sternal aspirates, iliac crest biopsies and biopsy imprints from 31 patients with verified metastatic cancer to bone marrow were reviewed. All three methods were shown to be complementary, as cancer cell deposits were detected in some cases by one procedure and missed by the others.