The role of heterolactic lactobacilli in diarrhoea of short small bowel patients

Patients with a short small bowel (SSB) suffer continuously from abdominal pain, flatulence and diarrhoea. Their faeces contains a very characteristic flora, that normally consists of /70% (sometimes even up to 99%) of lactobacilli. In this study, we intended to prove that the mentioned inconveniences are mainly caused by fermentative activity of the massively present heterolactic lactobacilli. Bubbling SSB faeces was examined for bacterial composition and gas production. The effect of oral feeding was studied in a parenterally fed SSB girl and the effect of glucose loading on biochemical and microbiological parameters and on symptoms was studied in an SSB woman. Faecal flora of these SSB patients consisted of /85% lactobacilli. Of these, just Lactobacillus fermentum (10 cfu/g wet faeces) produced CO2 as the only gas in the bubbling faeces. The parenterally fed SSB girl suffered from flatulence, abdominal pain and diarrhoea after oral feeding. Soon after the glucose loading the abdomen of the woman became very distended and painful, and the patient became increasingly flatulent and sick due to massive intestinal CO2 production. After enormous deflation and diarrhoea all symptoms had gone. The data presented here demonstrate that intestinal heterolactic lactobacilli, such as L. fermentum, give rise to abundant CO2 production and concomitant flatulence, abdominal pain and diarrhoea.