ROLE OF BACTERIA IN THE PATHOGENESIS OF SHORT-BOWEL SYNDROME-ASSOCIATED D-LACTIC ACIDEMIA

Previously we have demonstrated that short bowel syndrome (SBS) patien ts suffer daily from D-lactic acidemia; in these patients rather high amounts of (bacterial) D-lactate emerge in blood and urine with a circ adian rhythm. The aim of this study was to establish the microbial bas is of D-lactic acidemia in SBS. Therefore, faecal flora of (young and adult) SBS-patients was analysed qualitatively and quantitatively, and compared to that of controls. The isolated bacterial species were scr eened for massive D- and/or L-lactate production after in vitro growth . After introduction of oral feeding in SBS-infants shortly after the resection, lactobacilli increased from less than or equal to 1% up to 60+/-5% of the faecal flora within 2-3 weeks. In the faeces of patient s with oral feeding the lactate producers Lactobacillus acidophilus an d Lactobacillus fermentum were the major resident bacteria (each with 10(10)-10(12) cfu/g faeces). During active growth in vitro these lacto bacilli produced massive amounts of D- and L-lactic acid from glucose. Use of oral antibiotics in two SBS-children did not reduce the total numbers of lactobacilli, but caused shifts within the intestinal popul ations of at east lactobacilli. It is concluded that the strongly redu ced intestinal capacity for carbohydrate absorption and the oral consu mption of easily fermentable carbohydrates form the physiological basi s for D-lactic acidemia in SBS, and that the fermentative D-lactate pr oduction by intestinal bacteria, especially the abundant, resident lac tobacilli, forms its microbial basis. In these patients the antimicrob ial and therapeutic effects of antibiotics are unpredictable. (C) 1997 Academic Press Limited.