American Journal of Clinical Nutrition, Vol 23, 1545-1558, Copyright © 1970 by The American Society for Clinical Nutrition, Inc.

Tropical Sprue and Malnutrition in West Bengal

I. Intestinal Microflora and Absorption

¹ From the Johns Hopkins Center for Medical Research and Training, Calcutta, India

Small bowel bacterial flora and absorptive function were studied in three groups of subjects; namely, patients with tropical sprue (15), patients with malnutrition without malabsorption (7), and normal individuals (13). Except for fat and B₁₂ malabsorption, the tropical sprue and malnourished cases could not be differentiated by biochemical studies. Low serum folate, megaloblastic anemia, and reduced serum albumin were seen as frequently in both groups.

Bacterial overgrowth of the upper small bowel was noted in all of the sprue cases; in five patients colonic bacteria were present in the stomach. The most consistent finding was an increase in numbers of coliforms. Four of seven malnourished patients also had coliforms in the upper bowel, but the concentrations were less than 10⁴/ml. In normal individuals, coliforms could not be cultured from the stomach, duodenum, or jejunum.

Bacterial populations in the small bowel declined during therapy in seven of nine sprue cases and one malnourished subject. Of six sprue patients treated with antibiotics, four showed dramatic improvement of fat and B₁₂ absorption and decreased small bowel bacterial concentrations within 48 hr; resistant bacteria and antibiotic toxicity were responsible for the delayed response in two patients. Minimal abnormalities of the small bowel microflora were seen in two sprue patients in whom improvement in absorption could not be well correlated with changes in bacteriology. Thus, bacterial overgrowth of the small bowel was present in tropical sprue and to a lesser extent, in malnutrition, but the bacteria were interfering with absorption in 80% of the sprue cases and were acting as commensals in the malnourished individuals.