Skip to main content

Duodenal microflora

A prospective study in pediatric gastrointestinal disorders

Abstract

Culture of the duodenal microflora was performed on 96 infants and children with a variety of gastrointestinal disorders. The resident microflora consists predominantly of oral-type microorganisms such as α-Streptococci andNeisseria. A fecal-type microflora was found in all 6 infants with postsurgical diarrhea and temporary monosaccharide intolerance; 4 of 22 patients with protracted diarrhea of infancy, 3 of 22 patients with celiac disease, and none of 32 patients with nonspecific diarrhea or 14 others with miscellaneous disorders. Anaerobic microorganisms were seldom isolated. Only 9% of the duodenal cultures were completely sterile, although a further 17 had a quantitative culture less than 5 × 104 microorganisms/ml. Smallbowel contamination with fecal-type microorganisms is associated with stasis and disturbance of the normal peristaltic-clearing mechanism. Duodenal culture is essential in any infant with temporary monosaccharide intolerance. It is occasionally useful in other situations where motility may be disturbed.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Donaldson RM Jr: Normal bacterial populations of the intestine and their relation to intestinal function. N Engl J Med 270:938–1056, 1964

    PubMed  Google Scholar 

  2. 2.

    Kalser MH, Cohen R, Arteaga I, Yawn E, Mayoral L, Hoffert WR, Frazier D: Normal viral and bacterial flora of the human small and large intestine. N Engl J Med 274:500–562, 1966

    PubMed  Google Scholar 

  3. 3.

    Gorbach SL, Plaut AG, Nahas L, Weinstein L, Spanknebel G, Levitan R: Studies of Intestinal Microflora II. Microorganisms of the Small Intestine and Their Relations to Oral and Fecal Flora. Gastroenterology 53:856–867, 1967

    PubMed  Google Scholar 

  4. 4.

    Tabaqchali S: The Pathophysiological Role of Small Intestinal Bacterial Flora. Scand J Gastroent Suppl 6:139–163, 1970

    Google Scholar 

  5. 5.

    Davison WC: The Duodenal Contents of Infants in Health, and During and Following Diarrhea. Am J Dis Child 29:743–756, 1925

    Google Scholar 

  6. 6.

    Blacklock JWS, Guthrie KJ, Macpherson I: A Study of the Intestinal Flora of Children. J Path Bact 44:321–335, 1937

    Google Scholar 

  7. 7.

    Barbero GJ, Runge G, Fischer D, Crawford MN, Torres FE, Gyorgy P: Investigations on the Bacterial Flora, pH, and Sugar Content in the Intestinal Tract of Infants. J Pediat 40:152–163, 1952

    PubMed  Google Scholar 

  8. 8.

    Anderson CM, Langford RF: Bacterial content of small intestine of children in health, in coeliac disease, and in fibrocystic disease of pancreas. Br Med J 1:803–806, 1958

    Google Scholar 

  9. 9.

    Challacombe DN, Richardson JM, Rowe B, Anderson CM: Bacterial microflora of the upper gastrointestinal tract in infants with protracted Diarrhoea. Arch Dis Child 49:270–277, 1974

    PubMed  Google Scholar 

  10. 10.

    Challacombe DN, Richardson JM, Anderson CM: Bacterial Microflora of the Upper Gastrointestinal Tract in Infants without Diarrhoea. Arch Dis Child 49:264–269, 1974

    PubMed  Google Scholar 

  11. 11.

    Gorbach SL, Mitra R, Jacobs B, Banwell JG, Chatterjee BD, Mazumder DN: Bacterial Contamination of the Upper Small Bowel in Tropical Sprue. Lancet 1:74–77, 1969

    PubMed  Google Scholar 

  12. 12.

    Beeken WL, Kanich RD: Microbial flora of the upper small bowel in Crohn's disease. Gastroenterology 65:390–397, 1973

    PubMed  Google Scholar 

  13. 13.

    Ament ME, Ochs HD, Davis SD: Structure and function of the gastrointestinal tract in primary immunodeficiency syndromes. A study of 39 patients. Medicine 52:227–248, 1973

    Google Scholar 

  14. 14.

    Burke V, Anderson CM: Sugar intolerance as a cause of protracted diarrhoea following surgery of the gastrointestinal tract in neonates. Aust Paediat J 2:219–226, 1966

    Google Scholar 

  15. 15.

    Bishop RF, Anderson CM: The bacterial flora of the stomach and small intestine in children with intestinal obstruction. Arch Dis Child 35:487–491, 1960

    Google Scholar 

  16. 16.

    Burke V, Danks DM: Monosaccharide Malabsorption in Young Infants. Lancet 1:1177–1180, 1966

    Google Scholar 

  17. 17.

    Gracey M, Burke V, Anderson CM: Association of monosaccharide malabsorption with abnormal small intestinal flora. Lancet 2:384–385, 1969

    PubMed  Google Scholar 

  18. 18.

    Lifshitz F, Coello-Ramirez P, Gutierrez-Topete G: Monosaccharide intolerance and hypoglycemia in infants with diarrhea. I. Clinical course of 23 infants. J Pediatr 77:595–603, 1970

    PubMed  Google Scholar 

  19. 19.

    Coello-Ramirez P, Lifshitz F: Enteric microflora and carbohydrate intolerance in infants with diarrhea. Pediatrics 49:233–242, 1972

    PubMed  Google Scholar 

  20. 20.

    Hamilton JD, Dyer NH, Dawson AM, O'Grady FW, Vince A, Fenton JCB, Mollin DL: Assessment and significance of bacterial overgrowth in the small bowel. Q J Med 39:265–285, 1970

    PubMed  Google Scholar 

  21. 21.

    Shwachman H, Khaw KT, Antonowicz I: Diagnosis and treatment: Peroral intestinal biopsy. Pediatrics 43:460–462, 1969

    PubMed  Google Scholar 

  22. 22.

    Kerry KR, Anderson CM: A ward test for sugar in feces. Lancet 1:981–982, 1964

    Google Scholar 

  23. 23.

    Townley RRW, Khaw KT, Shwachman H: Quantitative assay of disaccharidase activities of small intestinal mucosal biopsy specimens in infancy and childhood. Pediatrics 36:911–921, 1965

    PubMed  Google Scholar 

  24. 24.

    Davidson M, Wasserman R: The irritable colon of childhood (chronic nonspecific diarrhea syndrome). Pediatrics 69:1027–1038, 1966

    Google Scholar 

  25. 25.

    Lloyd-Still JD, Shwachman H, Filler RM: Protracted diarrhea of infancy treated by intravenous alimentation. I. Clinical studies of 16 infants. Am J Dis Child 125:358–364, 1973

    PubMed  Google Scholar 

  26. 26.

    Shwachman H, Lloyd-Still JD, Khaw KT, Antonowicz I: Protracted diarrhea treated by intravenous hyperalimentation. 2. results of small intestinal biopsies. Am J Dis Child 125:365–368, 1973

    PubMed  Google Scholar 

  27. 27.

    Lloyd-Still JD, Grand RJ, Khaw KT, Shwachman H: The use of corticosteroids in celiac crisis J. Pediatr 81:1074–1081, 1972

    PubMed  Google Scholar 

  28. 28.

    Holt LE Jr, Textbook of Pediatrics. HL Barnett, AH Elnhorn (eds). New York, Appleton-Century-Crofts, 1968, p. 174

    Google Scholar 

  29. 29.

    Thomson S: The role of certain varieties of bacterium coli in gastroenteritis of babies. J Hygiene 53:357–367, 1955

    Google Scholar 

  30. 30.

    Frazer AC: New mechanism of vitamin deprivation, with special reference to sprue syndrome. Br Med J 2:731–734, 1949

    Google Scholar 

  31. 31.

    Smith HW, Crabb WE: The Faecal bacterial flora of animals and man: Its development in the young. J Pathol 82:53–66, 1961

    Google Scholar 

  32. 32.

    Drasar BS, Shiner M, McLeod GM: Studies on the intestinal flora I. The bacterial flora of the gastrointestinal tract in healthy and achlorhydric persons. Gastroenterology 56:71–79, 1969

    PubMed  Google Scholar 

  33. 33.

    Plant AG, Gorbach SL, Nahas L, Weinstein L, Spanknebel G, Levitan R: Intestinal microflora III. The microbial flora of human small intestinal mucosa and fluids. Gastroenterology 53:868–873, 1967

    PubMed  Google Scholar 

  34. 34.

    Dellipiani AW, Girdwood RH: Bacterial changes in small intestine in malabsorptive states and in pernicious anemia. Clin Sci 26:359–374, 1964

    PubMed  Google Scholar 

  35. 35.

    Tabaqchali S, Booth CC: Jejunal bacteriology and bile salt metabolism in patients with intestinal malabsorption. Lancet 2:12–15, 1966

    PubMed  Google Scholar 

  36. 36.

    Gracey M, Burke V, Oshin A, Barker J, Glasgow EF: Bacteria, bile salts, and intestinal monosaccharide malabsorption. Gut 12:683–692, 1971

    PubMed  Google Scholar 

  37. 37.

    Goldstein, F: Mechanisms of malabsorption and malnutrition in the blind loop syndrome. Gastroenterology 61:780–784, 1971

    PubMed  Google Scholar 

  38. 38.

    Midtvedt T, Norman A: Bile acid transformation by microbial strains belonging to genera found in intestinal contents. Acta Pathol Microbiol Scand 71:629–638, 1967

    PubMed  Google Scholar 

  39. 39.

    Mallory A, Savage D, Kern F Jr, Smith JG: Patterns of bile acids and microflora in the human small intestine. Gastroenterology 64:34–42, 1973

    PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to John D. Lloyd-Still MB, MRCP.

Additional information

Supported in part by a grant from the National Cystic Fibrosis Research Foundation.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lloyd-Still, J.D., Shwachman, H. Duodenal microflora. Digest Dis Sci 20, 708–715 (1975). https://doi.org/10.1007/BF01070827

Download citation

Keywords

  • Public Health
  • Diarrhea
  • Celiac Disease
  • Monosaccharide
  • Gastrointestinal Disorder