Intestinal Flora In Patients Research Articles

Fecal microbiota transplantation for ulcerative colitis: a prospective clinical study

BackgroundFecal microbiota transplantation may contribute to disease remission in ulcerative colitis; however, the factors that determine the effects of treatment remain unknown. The aim of the present study was to prospectively investigate the clinical efficacy of fecal microbiota transplantation in patients with ulcerative colitis and identify the bacterial signatures associated with clinical remission.MethodsA total of 20 patients with ulcerative colitis were included in this prospective and uncontrolled study. All patients underwent gastroscopy five times, once every 3 weeks. Clinical indices were used to assess the efficacy of fecal microbiota transplantation, as well as the Mayo score, a score used to evaluate the extent of intestinal mucosal lesions in patients with ulcerative colitis. The changes in intestinal flora were detected by 16S ribosomal RNA-sequencing, and the relationship between ulcerative colitis and intestinal flora was analyzed.ResultsAfter treatment, clinical index scores for diarrhea, abdominal pain, and blood stool decreased significantly (p < 0.05). Erythrocyte sedimentation rate and C-reactive protein levels had not changed significantly; however, the clinical index score for intestinal mucosal lesions and the Mayo score decreased significantly. In addition, 16S ribosomal RNA-sequencing revealed that the intestinal flora in patients diagnosed with ulcerative colitis was different from that of donors.ConclusionFecal microbiota transplantation has a potential therapeutic value for the treatment of ulcerative colitis as it changes the abundance of bacterial flora and improves the scores for diarrhea, abdominal pain, and mucous membrane lesions in patients with this disease.Trial registrationThe clinical trial was retrospectively registered with ClinicalTrials.gov (NCT03016780) on January 11th, 2017.

Changes of intestinal flora in patients with systemic lupus erythematosus in northeast China.

ObjectiveThe human gut harbors diverse microbes that play a fundamental role in the well-being of their hosts. Microbes can cause autoimmunity, trigger autoimmunity in genetically susceptible individuals or prevent autoimmunity. There were reports about intestinal flora changes in Systemic Lupus Erythematosus (SLE) patients, but no data were available in northeast China. In this study, we investigated the intestinal flora changes of SLE patients in Heilongjiang province located in northeast China.MethodsFeces from 16 SLE patients and 14 healthy volunteers were employed to extract bacterial DNA, amplify 16s RNA of bacteria, and analyze the biological information by sequencing. The statistical analysis used the SPSS version of 17.ResultWe found that there were 1 phylums, 4 families and 9 genera in the intestinal flora of SLE patients. And the nine differences genera can be used to distinguish SLE patients from normal people.ConclusionWe found an increase of Proteobacteria and a decrease of Ruminococcaceae in SLE patients in different regions. In addition, we found that some proteins, enzymes, and diseases were significantly associated with SLE.

Effect of fecal microbiota transplantation on gastrointestinal function and intestinal flora in patients with ulcerative colitis

Effect of fecal microbiota transplantation on gastrointestinal function and intestinal flora in patients with ulcerative colitis

GW29-e1224 The analysis of the diversity of the intestinal flora in patients with acute myocardial infarction

GW29-e1224 The analysis of the diversity of the intestinal flora in patients with acute myocardial infarction

Gut microbiota injury in allogeneic haematopoietic stem cell transplantation.

Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is considered to be the strongest curative immunotherapy for various malignancies (primarily, but not limited to, haematologic malignancies). However, application of allo-HSCT is limited owing to its life-threatening major complications, such as graft-versus-host disease (GVHD), relapse and infections. Recent advances in large-scale DNA sequencing technology have facilitated rapid identification of the microorganisms that make up the microbiota and evaluation of their interactions with host immunity in various diseases, including cancer. This has resulted in renewed interest regarding the role of the intestinal flora in patients with haematopoietic malignancies who have received an allo-HSCT and in whether the microbiota affects clinical outcomes, including GVHD, relapse, infections and transplant-related mortality. In this Review, we discuss the potential role of intestinal microbiota in these major complications after allo-HSCT, summarize clinical trials evaluating the microbiota in patients who have received allo-HSCT and discuss how further studies of the microbiota could inform the development of strategies that improve outcomes of allo-HSCT.

Relationship between functional constipation and brain-gut-microbiota axis

Although with the higher prevalence, the overall treatment result of functional constipation is still not satisfied at home and abroad. The diagnosis and treatment of functional constipation are still to focus on colon itself. Functional constipation has complex interactions among intestinal flora, intestinal autonomic nerve and central nervous system. Patients with functional constipation have different degrees of mental and psychological dysfunction, and abnormal brain function can result in disorders of colon dynamics, secretion and immune function. At the same time, there is a significant imbalance of intestinal flora in patients with functional constipation. Intestinal flora plays an important role in the release of neurotransmitter and the activity of hypothalamic-pituitary-adrenal axis (HPA axis). Intestinal flora is an important regulator of development, maturity and activity of central nervous system. Therefore, the interaction in the brain-gut-microbiota axis may provide a broader strategy for the diagnosis and treatment of functional constipation and neuropsychiatric disorder.

Relationship between intestinal flora and inflammatory factors in patients with nonalcoholic steatohepatitis.

This study was conducted to analyze the change in intestinal flora of patients with nonalcoholic steatohepatitis and its correlation to the levels of the inflammatory cytokines interleukin-10 (IL-10) and IL-17. We selected 90 patients that were diagnosed with and treated for nonalcoholic steatohepatitis as the patient group and 80 healthy cases as the control group. We then compared the intestinal flora in the subject feces and the intestinal colonization resistance (B/E, Bifidobacterium to Enterobacter) of both groups. Using RT-PCR, we also detected IL-10 and IL-17 mRNA levels in the peripheral blood mononuclear cells of both groups. Furthermore, we used the ELISA method to determine serum IL-10 and IL-17 levels in order to explore the correlation between IL-10, IL-17 and B/E. The number of Bifidobacterium and Lactobacillus were significantly lower in the patient group than the control group (P<0.05), while Enterobacter and Enterococcus pathogenic bacteria were significantly higher in the patient group than the control group (P<0.05). The B/E value was lower in the patient group than the control group (P<0.05). The relative expression of IL-10 and IL-17 mRNA in the patient group was significantly higher than in the control group (P<0.05). In the patient group, the serum IL-10 levels were 1.17±0.15 pg/ml, which is significantly higher than the control group serum IL-10 levels which were 0.32±0.04 pg/ml (P<0.05). The serum IL-17 levels in the patient groups were 0.96±0.11 pg/ml, which was significantly higher than the control group, which had an average of 0.28±0.01 pg/ml serum IL-17 levels (P<0.05). Pearson's correlation analysis showed that the change of B/E value of intestinal flora in the patients group were negatively correlated with serum IL-10 (r=−0.546, P<0.05), and negatively correlated with serum IL-17 (r=−0.535, P<0.05). Therefore, compared to healthy people, the expression of IL-10 and IL-17 in the peripheral blood of patients with non-alcoholic fatty liver is high. The changes in intestinal flora in patients with nonalcoholic steatohepatitis are closely related to the changes of serum IL-10 and IL-17 levels, and they are involved in the development of nonalcoholic steatohepatitis.

Probiotic Treatment Improves Outcome of Chronic Hepatic Encephalopathy in BDL Rats, an In Vivo Longitudinal 1H MRS Study

Background: It is now accepted that intestinal dysbiosis is present in many diseases and plays an important role in their evolution/progression. Appropriate modulation of intestinal flora in patients with CLD may decrease intestinal ammonia production, reduce pro-inflammatory mechanisms in the gut thereby impacting intestinal permeability and consequent bacterial translocation. Therefore, our aim was to investigate the potential therapeutic effect of probiotic treatment with anti-inflammatory proprieties (VSL#3; actually available as Vivomixx® in EU and Visbiome in USA®) in CLD-induced HE. Methods: Probiotic treatment (VSL#3) was initiated 2 weeks before bile duct ligation (BDL) and was administrated daily by gavage (60-billion bacteria/kgrat) during the whole study. 38 adult Wistar male rats were divided into 4 groups: BDL-rats without treatment (‘BDL’, n = 14), BDL-rats + VSL#3 (‘BDL + VSL#3’, n = 14), sham-operated animals without treatment (‘sham’, n = 5) and shams + VSL#3 (‘sham + VSL#3’, n = 5). 1H-MRS in hippocampus was performed on a 9.4T-MR system using ultra-short-echo-time (TE = 2ms) sequence at week 0, 2, 4, 6 and 8, together with blood sampling to measure plasma bilirubin and NH4+. Open field test evaluated motor activity at week4, 6 and 8. Faeces were collected before treatment and every 2 weeks thereafter. Results and discussion: Increased plasma bilirubin confirmed the presence of CLD in both, BDL + VSL#3 and BDL-rats, with no difference between the two groups. However, important reduction of plasma NH4+ was observed in BDL + VSL#3 animals (Figure 1). Longitudinal in vivo 1H-MRS-measure of brain metabolites reinforced the positive findings about the effect of probiotic treatment. There was significantly smaller increase in brain Gln in BDL + VSL#3(+107%) compared to untreated BDL(+138%) at week 8 (P = 0.03). While the sum of osmolytes in BDL + VSL#3 was constant throughout the length of the study, the untreated BDL rats showed an incomplete osmoregulatory response. Moreover, the increase of brain Gln in the BDL + VSL#3 group correlated negatively with their increase of genus Bifidobacteria in gut microbiota, suggesting a positive treatment effect. Differences among other brain metabolites are presented in Table 1. With regards to behavioural tests: BDL + VSL#3 did not show the typical significant decrease in motor activity during the course of the disease, something we did observe in the BDL group. Interestingly, a subset (∼30%) of treated rats did not display the characteristic increase in brain Gln and they had very stable performance in behavioural tests (all in CLD-condition proved by increased plasma bilirubin). Suggesting that in some individuals, VSL#3 may be highly protective.Table 1Changes in Brain Metabolites Expressed as %-Change Between Week 0 (pre-BDL) and Week 8 (Post-BDL) and Corresponding P-value for This Change.MetaboliteBDLBDL + VSL#3Glutamine+138%, ****+107%, **myo-Inositol−33%, ****−24%, ***Taurine−8%, **−13%, ****Total Choline−25%, ***−20%, nsSum of osmolytes (Gln + mIns + Tau + tCho)+9%, ***0%, ns Open table in a new tab Conclusions: In BDL-rats, VSL#3 probiotic treatment was associated with positive effect on plasma NH4+, brain metabolite changes and motor activity, which may be related to increase Bifidobacteriae in the gut. In a subset of animals, the effect seemed profound given that the characteristic neurometabolic profile with increased Gln was not observed. Taken together, these results are promising and warrant further investigation. The clinical implications of these findings are potentially far-reaching given that probiotics are generally safe and well-tolerated. The authors have none to declare.

22 Prevalence of ciprofloxacin-resistant E.coli in the intestinal flora of patients undergoing transrectal prostate biopsy in Dartford, UK

22 Prevalence of ciprofloxacin-resistant E.coli in the intestinal flora of patients undergoing transrectal prostate biopsy in Dartford, UK

Is fecal microbiota transplantation (FMT) an effective treatment for patients with functional gastrointestinal disorders (FGID)?

Despite its high prevalence and significant effect on quality of life, the etiology of functional gastrointestinal disorders (FGID), and specifically irritable bowel syndrome (IBS), has yet to be fully elucidated. While alterations in immunity, motility, and the brain-gut axis have been implicated in disease pathogenesis, the intestinal microbiota are increasingly being shown to play a role and numerous studies have demonstrated significant differences from normal in the intestinal flora of patients with FGID, and between types of FGID. Fecal microbiota transplantation (FMT) is a curative therapy for Clostridium difficile infection (CDI), a disease hallmarked by intestinal dysbiosis, and FMT is now being explored as a means to also restore intestinal homeostasis in FGID. This review aims to investigate the role of intestinal microbiota in the pathogenesis of FGID, the implications of FMT for the treatment of FGID, and the challenges encountered in measuring response to a specific intervention in patients with FGID.

Influence of cefroxadine dry syrup on intestinal bacterial flora

Influence of cefroxadine (CXD) dry syrup on intestinal bacterial flora was studied in mice infected with 4 species of bacteria, namely, Escherichia coli, Enterococcus faecalis, Bacteroides fragilis and Bifidobacterium breve, and in pediatric patients having infections in the respiratory tract and cutaneous/soft tissues. The results were summarized as follows: CXD dry syrup was administered for 5 consecutive days to mice infected with the 4 species. No considerable changes were observed in levels of bacteria in the feces and in different parts of digestive tracts. Eleven pediatric patients were orally administered with 30-54 mg/kg of CXD dry syrup a day for 7-15 consecutive days. Symptom of diarrhea was noted in 2 patients. Dominant species of the intestinal flora such as E. coli, Bifidobacterium, and Bacteroides sometimes decreased in patients treated with CXD dry syrup. In general, however, decreases in numbers of these bacteria were insignificant. Changes of intestinal flora in patients treated with CXD dry syrup were apparently smaller than those treated with ampicillin and were similar to those treated with cephalexin or amoxicillin.

Intervention effect of microbiological capsules containing Bacillus subtilis and Enterococcus on intestinal flora in patients with NASH

Intervention effect of microbiological capsules containing Bacillus subtilis and Enterococcus on intestinal flora in patients with NASH

Effect of Probiotics on Serum Bile Acids in Patients with Ulcerative Colitis

Evaluation of bile acids (BA) is useful for assessing the changes of intestinal flora in patients with ulcerative colitis (UC). During enterohepatic circulation, the intestinal micro flora cause 7 alpha-dehydroxylation of cholic acid (CA) and chenodeoxycholic acid (CDCA), yielding deoxycholic acid(DCA) and lithocholic acid, respectively. The aim of the present study was to investigate the effects of probiotics in patients with UC by examining changes of the serum BA profile. Twenty-seven patients were divided into the following 2 groups based on endoscopic findings: Fifteen patients with distal UC (dUC group) and 12 patients with pancolitis (pUC group). After treatment with mesalazine or salazosulfapyridine (5-ASA), all patients achieved remission. Then they were given 5-ASA plus the probiotic Clostridium butyricum Miyairi (3.0 g/day) for 4 weeks. After 4 weeks of probiotic treatment, %CDCA was significantly higher and %DCA was significantly lower in the pUC group than in the HV group. In contrast, the dUC group showed no significant differences of %CDCA or %DCA from the HV group after 4 weeks. Probiotic therapy restored intestinal flora involved in 7 alpha-dehydroxylation in the dUC group, but not in the pUC group.

PREVALENCE OF ANTIMICROBIAL RESISTANCE IN INTESTINAL FLORA OF PATIENTS UNDERGOING PROSTATIC BIOPSY: IMPLICATIONS FOR PROPHYLAXIS AND TREATMENT OF INFECTIONS AFTER BIOPSY

OBJECTIVE To determine the prevalence of antimicrobial resistance in intestinal flora of patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsies (TGB) and to examine if this information is useful in selecting appropriate antimicrobial agents for prophylaxis and treatment of biopsy-associated infections. PATIENTS AND METHODS In 2007 and 2008, rectal swabs were cultured from patients before undergoing TGB. Antimicrobial sensitivity of coliforms to amikacin, ciprofloxacin and coamoxiclav was determined. Laboratory records were used to identify patients who had bacteraemia or significant bacteriuria within 30 days of the TGB and the antimicrobial sensitivity pattern of these organisms were compared to those from the rectal swab. RESULTS Of 592 patients who had TGB, 445 (75.1%) had a rectal swab beforehand; 0.2%,10.6% and 13.3% of the coliforms were resistant to amikacin, ciprofloxacin and coamoxiclav, respectively. After TGB, six patients presented with urinary tract infections (UTI) and two with bacteraemia. All the infections were caused by coliforms except one UTI which was caused by ciprofloxacin-sensitive Pseudomonas aeruginosa. The blood culture isolates were sensitive to amikacin but resistant to ciprofloxacin and coamoxiclav. All the coliforms in the urine were resistant to ciprofloxacin but sensitive to coamoxiclav. Urine isolates were not tested for amikacin sensitivity. There was a strong correlation between the antimicrobial sensitivity of the coliforms from the rectal swabs and those cultured from urine or blood in both patients for amikacin, six of eight for ciprofloxacin and seven of eight for coamoxiclav. CONCLUSIONS Our study shows that in the coliforms in the bowel flora of our local population there is a relatively high level of resistance to ciprofloxacin and coamoxiclav, and very low level of resistance to amikacin. As there was a strong correlation between the antimicrobial sensitivity of organisms causing infections after TGB and those isolated from the rectal swabs, we conclude that rectal swab cultures before TGB provide useful evidence for selecting appropriate antimicrobials for prophylaxis and treatment of TGB-associated infections.

Purple Urine Bag Syndrome

A 97-year-old man presented with complaints of “purple urine” and constipation. The patient had a chronic indwelling urethral catheter secondary to urinary retention from prostate hyperplasia. Physical examination found a urine bag with purple discoloration (Fig. 1). Urine cultures grew Klebsiella pneumoniae. Following treatment with ciprofloxacin, his urine returned to a normal color. Figure 1 Purple discoloration of urinary bag and catheter tubing. Purple urine bag syndrome (PUBS) is an uncommon disorder in which the urine bags of catheterized patients turn purple or blue. First described in 1978, most patients are bedridden, cognitively impaired, and constipated.1 The discoloration is attributed to indigo (blue-violet) and indirubin (red-violet) pigments, which appear purple when combined. The pigments are created when ingested tryptophan is exposed to intestinal flora in patients with altered gut motility. Delayed gut transport allows coliforms to deaminate tryptophan to indole, which is absorbed and conjugated in the liver to indoxyl sulfate. Indoxyl sulfate is then catalyzed by sulfatases or phosphatases in the urine to indoxyl. Lastly, depending on urine pH and oxygen concentration, indoxyl is converted to indigo (high pH) and/or indirubin (low oxygen)2,3. PUBS is usually associated with organisms that have indoxyl phosphatase/sulfatase activity (Klebsiella pneumoniae, Providencia stuartii, Enterobacter spp., Proteus mirabilis, Morganella morganii, and Escherichia coli).

Effects of Probiotics on Serum Bile Acids in Patients With Ulcerative Colitis

BACKGROUND/AIM: Evaluation of bile acids (BA) is a useful method for assessing changes of the intestinal flora in patients with ulcerative colitis (UC). During enterohepatic circulation, conjugated BA is deconjugated to free BA by intestinal bacteria. The presence of intestinal microflora (Clostridium and Eubacterium) leads to 7 alpha-dehydroxylation of cholic acid (CA) and chenodeoxycholic acid (CDCA), yielding deoxycholic acid (DCA) and lithocholic acid, respectively. It was reported that the Lachnospiraceae subgroup of Firmicutes (including Clostridium) are decreased in the colon of UC patients compared to controls without inflammatory bowel disease. We have already reported that the serum%CDCA is significantly higher in patients with UC than in healthy volunteers (HV), while serum%DCA is significantly lower in UC patients than in HV, and these changes do not depend on the activity or extent of UC. The aim of the present study was to elucidate the effects of probiotics in patients with UC by examining the serum BA profile. PATIENTS/METHODS: The study population was 27 patients in whom UC was diagnosed from endoscopic and histological findings. All patients underwent ileocolonoscopy with appropriate biopsies. They were divided into the following 2 groups based on endoscopic findings: 15 patients with distal UC (dUC) and diffuse changes extending from the rectum to the splenic flexure, and 12 patients with more extensive UC or pancolitis (pUC). Treatment was givenwithmesalazine or salazosulfapyridine (5-ASA) and all patients achieved remission. After entering remission, they were treated with by 5-ASA plus the probiotic Clostridium butyricum Miyairi (MIYA) (3 g/day) for 4 weeks. The control group was composed of 8 HV. Routine laboratory tests were performed on the basis of clinical need, while fasting serum samples for measurement of BA were obtained before and after treatment with 5-ASA plus MIYA for 4 weeks. Serum BA fractions were analyzed by HPLC. RESULTS: There were no significant differences of serum total BA among the 3 groups. Before treatment, %CDCA was significantly higher in the dUC and pUC groups than in the HV group, while %DCA was significantly lower than in the HV group. In the pUC group, %CDCA was significantly higher and %DCA was significantly lower than in the HV group after 4 weeks of probiotic treatment. In the dUC group, however, there was no significant difference of %CDCA or %DCA after 4 weeks compared with the HV group. There were no significant differences in the ratio of conjugated BA to total serum BA among the three groups. CONCLUSIONS: These results suggest that intestinal bacteria involved in the deconjugation of BA are restored when patients achieve remission of UC by treatment with 5-ASA, and thatMIYA restoredmicroflora involved in 7 alpha-dehydroxylation in the dUC group, but not in the pUC group.

Effects of probiotic fermented milk on symptoms and intestinal flora in patients with irritable bowel syndrome: A randomized, placebo-controlled trial

Objective. The effect of probiotics on IBS symptoms has been mixed, but remains an intriguing treatment option with appeal to the patient. Material and methods. Patients fulfilling the Rome II criteria were randomized double-blind to a daily intake of 500 ml of fermented milk containing at least 5 × 107 CFU/ml of Lactobacillus paracasei ssp paracasei F19, Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 or an equal volume of acidified milk for 8 weeks. Symptoms were assessed at baseline and weekly using a disease-specific validated symptom rating scale (IBS-SSI). The predefined primary outcome measure was patient reported adequate symptom relief. Adherence to study protocol were assessed by performing stool samples at the of the treatment period. Results. Eight-one patients were screened. Sixty-four patients were randomized; 18 patients did not complete the study due to protocol violations or withdrew due to lack of effect. Fifty-two patients (13 males) completed the study as per protocol; mean age was 51.3 years (range 29–67). The proportion of patients reporting adequate symptom relief increased in both patient groups, but there was not any statistical difference between the groups. IBS-SSI scores did not differ statistically between the groups at the end of the treatment period, but improved during the study period in both groups. Conclusions. During this 8-week trial gastrointestinal symptoms improved. However, there was no difference between treatment with fermented milk containing probiotics or acidified milk. The effect of probiotics on IBS symptoms remains uncertain and further studies are warranted.

Probiotic Yogurt Effects on Intestinal Flora of Patients with Chronic Liver Disease

Patients with chronic liver disease generally have intestinal flora imbalance that is related to the development and worsening of the disease. The purpose of this study was to evaluate the effects of probiotic yogurt on intestinal flora of patients with chronic liver disease. A randomized controlled trial, pretest-posttest control group design, was used. Patients were randomized to an experimental group (41 patients) or a control group (40 patients). Patients in the experimental group were given probiotic yogurt (one cup each time, three times per day for 14 days) containing Bacillus bifidus, Lactobacillus acidophilus, Lactobacillus bulgaricus, and Streptococcus thermophilus within 2 hours after meals. Levels of fecal flora, symptoms and signs, and laboratory examination indexes were collected. After intervention, the experimental group had a lower Escherichia coli count and reduced intestinal flora imbalance (p < .05). Comparison of the experimental and control groups after the intervention showed that the former had improved symptoms and signs, including significant improvement in debilitation, food intake, appetite, abdominal distension, and ascitic fluid (p < .05). Probiotic yogurt reduces the levels of intestinal flora imbalance and has an additional therapeutic effect on patients with chronic liver disease.

Intestinal dysbiosis in irritable bowel syndrome: etiological factor or epiphenomenon?

Evaluation of: Lyra A, Rinttilä T, Nikkilä J et al. Diarrhoea-predominant irritable bowel syndrome distinguishable by 16S rRNA gene phylotype quantification. World J. Gastroenterol. 15(47), 5936–5945 (2009).Irritable bowel syndrome (IBS) is a functional disorder of multifactorial origin. Recent interest has been directed to the potential role of intestinal microbiota in the pathophysiology and symptom generation of this syndrome. This hypothesis is supported by the evidence of an infectious trigger in a proportion of patients, the identification of changes in bacterial composition and the detection of antibodies against flagellin, a component of indigenous flora, and by the potential therapeutic modulation of intestinal microbiota with probiotics and nonabsorbable antibiotics in IBS. The study by Lyra et al. assessed fecal microbiota in IBS patients and controls by applying a set of 14 quantitative real-time PCR assays targeting 16S ribosomal RNA gene phylotypes putatively associated with IBS, based on 16S ribosomal RNA gene library sequence analysis. In addition, microbiota composition was investigated over time by applying statistically advanced analyses at three timepoints during 6 months of follow-up. The authors showed that the intestinal flora of patients with diarrhea-predominant IBS diverged significantly not only from controls but also from the other IBS subgroups. The results by Lyra et al. further support the hypothesis that intestinal microbial flora has a role in IBS pathophysiology, and foster the idea that abnormal microbiota may act by triggering local and systemic immune responses linked to symptom generation. Further studies are now needed to clarify the key role of intestinal microbiota (as opposed to a secondary effect) in this common human disease.

Changes in intestinal flora after administration of panipenem/betamipron or sulbactam/cefoperazone for treatment of postoperative infections in gastrectomy patients

To determine the effect of antibiotics used for the treatment of postoperative infections on the normal intestinal flora in patients who have undergone gastroenterological surgery, we performed a prospective randomized study in patients who had undergone distal gastrectomy. Cefazoline was administered up to postoperative day 3 for prophylaxis. For the treatment of postoperative infections, either panipenem/betamipron (PAPM/BP; n=5) or sulbactam/ cefoperazone (SBT/CPZ; n=5) was adminstered to ten patients with signs of postoperative infections. Feces were examined for bacteria before and 4 and 7 days after the commencement of administration of these therapeutic antibiotics. The anaerobic bacterial count decreased significantly in four of five patients treated with SBT/CPZ, from 1010.2±0.36/g before treatment to 105.22±3.51/g. In the PAPM/BPtreated group, the anaerobic bacterial count did not change after antibiotic therapy. We also investigated the major genera of colonic anaerobes, and found that the numbers of bifidobacteria were maintained during PAPM/BP administration. However, in the SBT/CPZ group, the number of bifidobacteria decreased to below the detection limit in four of five patients. Little change was observed in the aerobic bacterial count in either group. However, Enterobacteriaceae were replaced by enterococcus or candida in all patients from the SBT/CPZ group and in one of five patients from the PAPM/BP group. Physicians should be alert