Microbial Flora of the Upper Small Bowel in Crohn’s Disease

Abstract

To determine the frequency and significance of bacterial overgrowth in Crohn’s disease, aerobic and anaerobic microflora were quantified in 36 patients and correlated with the location of radiological abnormality, intestinal protein loss, and absorption of d-xylose, fat, and vitamin B12. Eleven patients had jejunal colony counts of 104 per ml or greater and were designated as a high colony group. In this group 8 patients had 22 absorptive defects, seven of which were attributable to bacterial overgrowth alone, and 15 were associated with a combination of high colony counts and disease or resection of the absorptive site. Three patients in the high colony group had normal xylose, fat, and B12 absorption. Organisms isolated from this group were Escherichia coli, Clostridia, bacteroides, Propionibacterium acnes, streptococci, enterobacter, Veillonella, and Candida albicans. In the low colony group, 7 patients had no absorptive abnormality, and in the remainder there were 20 defects attributable to the location of disease or resection, and seven unexplained defects. Excess protein loss and high urinary indican values were present in 27 patients and neither correlated with bacterial colony counts. Jejunal disease and enteroenteric fistula were more frequently associated with high colony counts and may have predisposed to jejunal contamination. Quantitative small bowel culture seems indicated in patients with Crohn’s disease who have multiple absorptive defects, especially if accompanied by jejunal disease or enteroenteric fistulae.