Abstract

Descriptions of the small intestinal microbiota are deficient and conflicting. We aimed to get a reliable description of the jejunal bacterial microbiota by investigating samples from two separate jejunal segments collected from the luminal mucosa during surgery. Sixty patients with morbid obesity selected for elective gastric bypass surgery were included in this survey. Samples collected by rubbing a swab against the mucosa of proximal and mid jejunal segments were characterized both quantitatively and qualitatively using a combination of microbial culture, a universal quantitative PCR and 16S deep sequencing. Within the inherent limitations of partial 16S sequencing, bacteria were assigned to the species level. By microbial culture, 53 patients (88.3%) had an estimated bacterial density of < 1600 cfu/ml in both segments whereof 31 (51.7%) were culture negative in both segments corresponding to a bacterial density below 160 cfu/ml. By quantitative PCR, 46 patients (76.7%) had less than 104 bacterial genomes/ml in both segments. The most abundant and frequently identified species by 16S deep sequencing were associated with the oral cavity, most often from the Streptococcus mitis group, the Streptococcus sanguinis group, Granulicatella adiacens/para-adiacens, the Schaalia odontolytica complex and Gemella haemolysans/taiwanensis. In general, few bacterial species were identified per sample and there was a low consistency both between the two investigated segments in each patient and between patients. The jejunal mucosa of fasting obese patients contains relatively few microorganisms and a core microbiota could not be established. The identified microbes are likely representatives of a transient microbiota and there is a high degree of overlap between the most frequently identified species in the jejunum and the recently described ileum core microbiota.

Highlights

  • Descriptions of the small intestinal microbiota are deficient and conflicting

  • The longstanding debate as to whether antibacterial mechanisms of the intestinal epithelium along with peristalsis prevent the formation of a resident jejunal microbiota, is still not r­ esolved1–4

  • No species was detected in more than 50% of the population and only six species/groups of species were found in more than 30% of participants: Enterobacteriales were only exceptionally detected; Escherichia coli in 3 patients (5%), Serratia grimesii/proteamaculans/liquefaciens in 3 patients (5%) and Klebsiella pneumonia complex in 2 patients (3%)

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Summary

Introduction

We aimed to get a reliable description of the jejunal bacterial microbiota by investigating samples from two separate jejunal segments collected from the luminal mucosa during surgery. Streptococcus, Prevotella, Veillonella and Fusobacterium are frequently detected genera along with a range of Proteobacteria including Enterobacteriales, Haemophilus spp. and Neisseria spp. These studies are typically based on indirect sample collection procedures like e­ ndoscopies, nasoileal c­ atheters18,23, ­capsules or from a­ utopsies. In an attempt to provide a comprehensive and methodically sound description of the jejunal microbiota, we collected samples from two separate jejunal segments in a cohort of 60 patients during scheduled gastric bypass

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