COMPARISON OF 3 METHODS TO OBTAIN UPPER SMALL-BOWEL CONTENTS FOR CULTURE

In this study of 27 patients with dyspepsia, we compared three methods for obtaining upper small bowel contents for culture: 1) the Enterote st or string capsule method, 2) duodenal intubation using a closed pol yethylene tube filled with water that had been boiled for sterilizatio n and removal of dissolved oxygen, and 3) brushing of duodenal mucosa with a cytology brush protected by a sheath (the last two done during endoscopy). In 12 of the 27 patients, duplicate intubations and brushi ngs were performed. The samples obtained were cultured aerobically. Pa rameters used to compare the three methods were: the contribution of e ach method to the diagnosis of upper small bowel bacterial overgrowth (USBBO), agreement between the methods in diagnosis of USBBO and in de tailed microbiological findings, and the reproducibility of diagnosis of USBBO and of microbiological findings in duplicate intubation and b rushing. Intubation and brushing were highly reproducible and superior to the Enterotest in all of the tested parameters. Intubation and bru shing are equally efficacious, but intubation is preferred because of the slight cost advantage, ease of specimen processing, and the abilit y to obtain anaerobic specimens.