BACTERIOLOGICAL METHOD FOR DETECTING SMALL-INTESTINAL HYPOMOTILITY

Objective: Small intestinal hypomotility is an important cause of smal l intestinal bacterial overgrowth, yet assessment of small intestinal motility in this setting is problematic. This study was performed to i nvestigate the validity of a bacteriological method for detecting smal l intestinal hypomotility. Methods: Twenty-five subjects without previ ous gastric surgery were studied with (i) concurrent bacteriological a nalyses of fasting saliva and gastric and proximal small intestinal as pirates, (ii) measurement of gastric pH, and (iii) scintigraphic asses sment of small intestinal transit rates of a liquid test meal. The rep roducibility of bacteriological analyses of saliva and small intestina l secretions was determined in 12 subjects. Results: Serial bacteriolo gical analyses of saliva and proximal small intestinal secretions yiel ded reproducible results over time periods of up to 1 month. Eleven su bjects were deemed to harbor Enterobacteriaceae of nonsalivary origin in proximal small intestinal secretions. Orocaecal transit, but not ga stric emptying, of a liquid test meal was significantly delayed in thi s group (p = 0.002 and p = 0.84, respectively), suggesting the presenc e of small intestinal hypomotility. Impaired gastric acidity unlikely confounded assessment of the origin of small intestinal Enterobacteria ceae in any instance. Conclusions: The presence of Enterobacteriaceae of nonsalivary origin in proximal small intestinal secretions may be t aken to reflect the presence of small intestinal hypomotility. The pre sence of impaired gastric acidity does not confound this approach. Bec ause small intestinal intubation and culture of aspirate are required anyway to accurately diagnose small intestinal bacterial overgrowth, t he simple addition of concurrent bacteriological analysis of saliva ma y allow small intestinal hypomotility to be detected at the same time as the presence or absence of small intestinal bacterial overgrowth it self is established, thus streamlining the investigation of subjects f or this disorder and its possible causes.