Small intestinal bacterial overgrowth in patients with rheumatoid arthritis

et al,' in which the authors demonstrated an altered character in the small bowel's bacterial flora in patients with rheumatoid arthritis. However, the authors did not demonstrate the presence of bacterial overgrowth. The syndrome of bacterial overgrowth is characterised by diarrhoea with malabsorption. The mechanism by which the bacterial overgrowth causes symptoms is not known. These symptoms are related to an increase in the luminal bacterial flora and the presence of obligate anaerobes (colonic luminal flora) as judged by jejunal fluid culture or breath tests. The patients in the study did not have any evidence of malabsorption or diarrhoea. The investigations used, apart from the bile acid deconjugation test, had not been previously validated in patients with bacterial overgrowth. Quantative bacterial culture was