The bacterial flora of aspirates from the stomach, the upper jejunum, the mid-gut, and the terminal ileum of 13 patients with Crohn's disease was compared with that obtained from similar sites in healthy subjects. The relationship of the bacterial flora to the site of disease and to the absorption of vitamin B and fat was examined.

Increased colonisation of the upper gut was seen only in patients with obvious stasis due to upper-gut disease, or when the upper and lower gut were connected by a fistula. In patients with comparatively normal motility, or in whom disease was restricted to the terminal small bowel, the flora was similar to that of healthy subjects. Aerobic diphtheroids were virtually absent from and higher counts of yeasts were present in all areas of the gut of patients with Crohn's disease.

No consistent relationship could be demonstrated between absorptive defects and the presence of an abnormal bacterial flora. Malabsorption of vitamin B12 usually depended more on loss or disease of the terminal ileum than on increased numbers of bacteria in the small gut. Three patients who showed significant deconjugation of bile salts had steatorrhoea but bacterial overgrowth, including species able to deconjugate bile salts, was not always associated with increased excretion of fat.


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