Stagnant Loop Research Articles

Impaired oxidation of antipyrine in stagnant loop rats.

The drug-metabolizing capacity of the liver was assessed in rats with experimental stagnant loop syndrome. Self-filling stagnant loops were created surgically in the upper jejunum. The capacity to metabolize foreign compounds by oxidation and conjugation was assessed in vivo after dosing of 14C-antipyrine and 3H-paracetamol. The rate of antipyrine metabolism was also tested in stagnant loop rats treated with lincomycin and in control rats with some of the features of the stagnant loop syndrome. Four weeks after the operation the biological half-life of antipyrine was increased by 78% compared with controls, and the metabolic clearance was decreased by 38%. Lincomycin treatment prevented the impairment of antipyrine metabolism in stagnant loop rats. Neither anemia, reduced food intake after a sham-operation, nor simple phenol ingestion changed antipyrine half-life of control rats. Phenobarbital treatment increased the metabolic clearance of antipyrine in stagnant loop rats, but post-treatment clearance val...

Osteomalacia in the stagnant loop syndrome

Osteomalacia in a 80-year old woman with malabsorption due to the stagnant loop syndrome is reported. The osteomalacia was associated with bacterial overgrowth in the small intestine and increased bile salt deconjugation. Although the mechanism of osteomalacia in the stagnant loop syndrome remains uncertain, it is suggested that abnormal flora reduce the absorption of vitamin D by deconjugation of bile salts in the lumen of the small intestine.

Duodenal Bile Acid Concentrations in Fat Malabsorption Syndromes

Meal-stimulated duodenal bile acid concentrations were measured in 38 control subjects and in 138 patients with various gastrointestinal diseases with or without fat malabsorption. In controls, the duodenal bile acid concentrations were normally distributed after Iogarithmic transformation, with a mean of 10.8 mM/1 (range: 5.4-21.5 mM/1). In general, the lower normal limit, 5.4 mM/1, discriminated well between patients with or without steatorrhea in whom other causes of fat malabsorption had been ruled out. The combination of intraluminal bile acid deficiency and steatorrhea was most often encountered in patientswit h hepatic disease, ileal disorders, and in the stagnant loop syndrome. Measurements of duodenal bile acid concentrations may serve to detect disorders of bile acid metabolism and thereby elucidate the pathogenesis of fat malabsorption syndromes.

Value of Urinary Simple Phenol and Indican Determinations in the Diagnosis of the Stagnant Loop Syndrome

The urinary excretion of phenol, p-cresol, and indican was determined in 7 patients with the stagnant loop syndrome, 26 patients with coeliac disease, chronic pancreatitis, and partial gastrectomy, and 18 control patients. The mean excretion of the compounds in the patients with the stagnant loop syndrome and in the control patients, respectively, was 77 and 2.3 mg/24 h of phenol (p less than 0.05), 164 and 39.5 mg/24 h of p-cresol (n.s.), and 369 and 41.5 mg/24 h of indican (p less than 0.01). When applied as diagnostic tests for the stagnant loop syndrome, the phenol excretion showed 2 false negative results, the p-cresol excretion 3 false negative and 2 false positive results, and the indican excretion 6 false positive results. The combined use of phenol and indican determinations eliminated the number of false positive results with the indican test, and was found most useful as screening procedure. Determination of phenol and indican in a 24-hour urine sample is likely to provide a simple method for selecting patients with signs of abnormal bacterial colonization in the small intestine for more detailed investigations.

Stagnant Loop Syndrome with Evidence of Bile Salt Deconjugation in a Child

Stagnant Loop Syndrome with Evidence of Bile Salt Deconjugation in a Child

The stagnant loop syndrome in childhood: review and report of four patients.

Four children presenting with a range of signs and symptoms were found to have chronic intestinal obstruction. Presentations included massive upper-gastronintestinal bleeding, chronic weight loss simulating neoplasm, andprofound megaloblastic anemia. The pathophysiology involved and a brief review of stagnant loop syndrome in childhood are discussed.

Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass

Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass.

Ileal blind loop in childhood.

A child had two stagnant loops of the terminal part of the ileum, resulting from a bypass operation in infancy for ileal atresia. The patient had an iron deficiency anemia that was shown at operation to be due to mucosal ulceration within the terminal part of the ileum. Diffuse nodular lymphoid hyperplasia was also demonstrated within the blind loop, and the mucosal ulceration and nodular lymphoid hyperplasia may be a response of the ileal mucosa to the increased counts of aerobic and anaerobic bacteria and to deconjugated intraluminal bile salts. Deconjugated bile salts and bacteria with deconjugating properties were also found in the upper part of the small intestine, showing that lesions of the terminal part of the ileum may be associated with metabolic abnormalities within the upper part of the small intestine.

Utilization of urea nitrogen for albumin synthesis in the stagnant loop syndrome

A study of urea and albumin metabolism was carried out in a patient with the stagnant loop syndrome and in a control subject using radioisotopic and stable isotopic techniques. The patient had a higher rate of urea synthesis, urea hydrolysis in the gut, and of incorporation of recycled urea nitrogen into albumin. Although only a small proportion (0.4%) of the urea nitrogen available was used for albumin synthesis and this constituted only 0.8% of the daily nitrogen requirement for this purpose, the reutilization of nitrogen was relatively much greater than was observed in the control study.

Taurocholate Metabolism in Patients with Small Intestinal Stagnant Loops

Taurocholate Metabolism in Patients with Small Intestinal Stagnant Loops

Value of small intestinal bile acid analysis in the diagnosis of the stagnant loop syndrome: T. C. Northfield, B. S. Drasar, and J. T. Wright.Gut 14:341–347, 1973

Value of small intestinal bile acid analysis in the diagnosis of the stagnant loop syndrome: T. C. Northfield, B. S. Drasar, and J. T. Wright.Gut 14:341–347, 1973

Duodenal Bacterial Flora and Bile Salt Patterns in Patients with Gastrointestinal Disease

Summary: Small intestinal intubation was performed in a total of 61 patients with gastrointestinal symptoms and six healthy volunteer subjects. Duodenal aspirates were collected in the fasting state and cultured aerobically and an-aerobically. The ratios of glycine to taurine conjugated bile salts, tri-hydroxy to di-hydroxy bile salts, and the percentage deconjugation of the bile salt were measured. No significant organisms were cultured from the duodenal aspirates of the six normal control subjects. In these controls less than 1% unconjugated bile salt was present in duodenal secretions. The glycine/taurine ratio averaged 2.7 and tri-hydroxy/di-hydroxy ratio 0.9. In contrast, 30 of 48 patients with gastrointestinal symptoms showed coliform colony counts of 105 organisms or greater per ml duodenal aspirate. None of the patients fulfilled the accepted criteria for the blind or stagnant loop syndrome and antibiotic therapy failed to reduce the steatorrhoea. Small amounts of deconjugated bile salts were found in the duodenal aspirates from many patients with a correlation between the percent unconjugated bile salts and the number of organisms cultured. It is concluded that significant coliform colonisation of the upper small intestine and some deconjugation of bile salts may be found in many patients with nonspecific gastrointestinal disease.

Intraluminal precipitation of bile acids in stagnant loop syndrome.

The postprandial concentrations of free and conjugated bile acids were measured in total content and micellar phase of jejunal aspirates from nine patients with steatorrhoea due to the stagnant loop syndrome and from 11 normal controls. Aspirates from the stagnant loop syndrome patients, but not from the normal controls, had a high concentration of free (unconjugated) bile acids. There was a reciprocal decrease in the concentration of conjugated bile acids, but total bile acid concentration in the whole aspirate remained normal. Total bile acid concentration in the micellar phase of intestinal content was reduced, indicating precipitation of bile acids. These findings suggest that precipitation of unconjugated bile acids, rather than passive absorption, leads to a reduced postprandial concentration of bile acids in the micellar phase of jejunal content, and are consistent with the hypothesis that fat malabsorption in the stagnant loop syndrome results from decreased micellar dispersion of lipolytic products.

Sensitivity and Specificity in Tests of Distal Ileal Function: Prospective Comparison of Bile Acid and Vitamin B12 Absorption in Ileal Resection Patients

Abstract Bile acid and vitamin B 12 absorption were compared prospectively in 22 patients with distal ileal resection, 7 with similar diarrhea but apparently normal ileal function, 5 with the stagnant loop syndrome, and 3 with steatorrhea due to digestive abnormalities. Also studied were 18 healthy control subjects. A test meal containing glycine- 14 C-labeled glycocholate, 3 H-ring-labeled taurocholate, vitamin B 12 - 57 Co with intrinsic factor, and 51 CrCl 3 as nonabsorbable marker was administered to fasting patients. Bile acid absorption was assessed by appearance of 14 CO 2 in breath and by fecal excretion of 14 C or 3 H; B 12 absorption was measured by excretion of 57 Co in urine (Schilling test). Based on fecal excretion of 3 H, nearly all patients with ileal resection had unequivocal bile acid malabsorption. Measurement of 14 CO 2 in breath was less sensitive since four false negatives were identified. Measurement of both 14 CO 2 and fecal 14 C was as sensitive as measurement of fecal 3 H. Of the 14 patients with resections less than 100 cm, 4 had normal Schilling tests, despite nearly all having bile acid malabsorption; both tests were equivocal or abnormal in patients with larger resections. In patients with similar diarrhea but no evidence of ileal dysfunction, bile acid malabsorption was not present, since the ratio of fecal bile acid radioactivity to marker radioactivity was significantly smaller than in patients with ileal resection; B 12 absorption was normal. The breath test appears to be a useful screening test for the detection of the stagnant loop syndrome. Its interpretation is uncertain in patients with ileal dysfunction, since such patients may also have bile acid malabsorption. Thus, the clinical value of the breath test or measurement of bile acid absorption in such patients probably can only be determined by future studies which relate test results to therapeutic response.

Value of small intestinal bile acid analysis in the diagnosis of the stagnant loop syndrome

We have studied simple methods of analysing bile acids in human small intestinal aspirates, in order to assess their suitability for the routine clinical investigation of patients with steatorrhoea. Following extraction into methanol, samples were analysed qualitatively for bile acid deconjugation by thin-layer chromatography and quantitatively by the 3-alpha-hydroxysteroid dehydrogenase enzyme assay. These methods were found to give good recoveries, and to be sensitive, accurate, and specific, in addition to being sufficiently simple and rapid for routine diagnostic purposes. This diagnostic procedure was applied to the identification of patients with steatorrhoea due to the stagnant loop syndrome, and was compared with other tests for this condition, viz, study of the small intestinal bacterial flora, urinary indican excretion, and the Schilling test with added intrinsic factor. Three groups of subjects were studied; group I consisted of nine patients with steatorrhoea due to the stagnant loop syndrome; group II (disease control group) of six patients with an anatomical stagnant loop that was not causing steatorrhoea; and group III (normal control group) of 11 subjects with no known gastrointestinal disease. The screening of postprandial upper jejunal samples for bile acid deconjugation proved the most useful diagnostic test, being positive in eight out of nine patients from group I, but in none of those from groups II and III. At lower levels of the small intestine, bile acid deconjugation was found in subjects from groups II and III. The other three diagnostic tests discriminated poorly between subjects from group I and those from group II.

Clinical Experience with a Simple Test for the Detection of Bacterial Deconjugation of Bile Salts and the Site and Extent of Bacterial Overgrowth in the Small Intestine

A simple test for detection of bacterial deconjugation of bile salts and the site and extent of bacterial proliferation in the small intestine is described. Intestinal aspirates were examined for presence of free bile salts by thin layer chromatography. Aliquots of the aspirates were passed through Millipore filters, and the filters, which retained the bacteria in the aspirate, were incubated for 2 hr with conjugated bile salts under aerobic and anaerobic conditions, and the bile salt composition of the incubation medium was determined. The bacterial counts of the aspirates were determined by counting the bacteria on the Millipore filters. The test was positive in all of 38 patients with documented stagnant loop syndrome, and this was associated with a bacterial count in excess of 106 per ml of aspirate and steatorrhea. With two exceptions, improvement after administration of antibiotics coincided with reversion of the deconjugation test to normal, decrease in the bacterial count, and disappearance or improvement of the steatorrhea. The test was positive in 1 of 45 individuals without diarrhea, and in 4 of 33 patients with diarrhea but no steatorrhea. The false-positive tests occurred in patients with either a Billroth II or a pyloroplasty; however, in none of these did the bacterial count exceed 106 per ml.

Uptake of Vitamin B12 by Intestinal Bacteria in the Stagnant Loop Syndrome

Schjonsby, H., Drasar, B. S., Tabaqchali. S. & Booth, C. C. 1973. Uptake of Vitamin Bj2 by Intestinal Bacteria in the Stagnant Loop Syndrome. Scand. J. Gastroent. 8, 41-47.Following a test meal wit...

Indicanuria as a Screening Test for the Stagnant Loop Syndrome After Gastric Surgery.

Excerpt Factors controlling the excretion of indican in patients after gastric surgery and in control subjects have been examined to determine the value of the measurement of indican. One hundred a...

Intrajejunal volatile fatty acids in the stagnant loop syndrome.

In the stagnant loop syndrome an abnormal anaerobic flora colonizes the small bowel. Anaerobic organisms are characterized by fermentation reactions leading to the production of volatile fatty acids. This paper describes the measurement of intrajejunal volatile fatty acid concentrations in 11 patients with the stagnant loop syndrome. Nine normal persons and 18 patients with gastrointestinal disease without intestinal stasis acted as controls. Acetate and propionate concentrations were greatly increased in the patients with the stagnant loop syndrome and returned to normal in those patients treated with antibiotics. The measurement of intrajejunal volatile fatty acid concentrations as an index of overgrowth of anaerobic organisms is discussed.

Small intestinal bile salt metabolism in normal subjects and in the stagnant loop syndrome.

Small intestinal bile salt metabolism in normal subjects and in the stagnant loop syndrome.