DECONJUGATION ABILITY OF BACTERIA ISOLATED FROM THE JEJUNAL FLUID OF PATIENTS WITH PROGRESSIVE SYSTEMIC-SCLEROSIS AND ITS GASTRIC PH

BACKGROUND/AIMS: Our goal was to demonstrate the role of bacteria in a ltered bile acid metabolism, which overgrow in the upper small intesti ne of patients with progressive systemic sclerosis. We identified the bacterial species, isolated from the jejunal fluid obtained from patie nts with progressive systemic sclerosis, who had previously shown an i ncrease in (CO2)-C-14, specific activity on breath test, and normal co ntrols. After which, we investigated the deconjugation ability of the isolated bacteria and the relationship between (CO2)-C-14, specific ac tivity and gastric pH. METHODOLOGY: Bile acid breath tests were perfor med on 12 patients, and 19 normal controls using 5 mu Ci of oral glyci ne-1-C-14-labeled glycocholate. Jejunal fluid was aspirated through a double lumen-tube with a rubber cover on the tip. Deconjugation abilit y was examined by thin-layer chromatography using conjugated bile acid s in ox gall. RESULTS: The following species were identified in jejuna l fluid samples obtained from patients: Bacteroides vulgatus, Eubacter ium lentum, enterococcus, Lactobacillus bifidus, Escherichia (E) coli, Aerobacter (A) aerogenes. Except for E. coli: and A. aerogenes, these species were capable of hydrolyzing conjugated bile acids in ox gall. The administration of chloramphenicol (Ig orally per day for 14 days in divided doses) significantly reduced the (CO2)-C-14, specific activ ity (p<0.05) in the patients with progressive systemic sclerosis. On t he other hand, nineteen healthy control subjects demonstrated no incre ase in CO2 excretion, and 16 of the 19 had no bacteria isolated from j ejunal fluid. The remaining healthy man showed an overgrowth of E. col i and Pseudomonas CP) aeruginosa, but the E. coli and P. aeruginosa di d not have the ability of deconjugation. CO2 specific activity of expi red breath samples in the patients with progressive systemic sclerosis was correlated with gastric pH (n=12, r=0.588, p<0.05). CONCLUSIONS: Our results demonstrated that some of the bacterial species that overg row in the upper small intestine of patients with progressive systemic sclerosis can deconjugate bile acids, and that a shift to neutral pH in gastric juice, may promote the bacterial overgrowth related to thei r impaired peristaltic activity.