Small intestinal bacterial overgrowth in patients with rheumatoid arthritis.

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Small intestinal bacterial overgrowth in patients with rheumatoid arthritis.

Henriksson AE, Blomquist L, Nord CE, Midtvedt T, Uribe A.

Department of Rheumatology, Karolinska Hospital, Stockholm, Sweden.

OBJECTIVES--To examine the microflora of the upper small intestine in

patients with seropositive rheumatoid arthritis (RA) using a combination

of microbial cultivation and tests for microbial metabolic activity.

METHODS--Twenty five patients with seropositive RA, 12 achlorhydric

control subjects, and 11 control subjects with normal gastric acid

secretion were investigated. Disease activity was evaluated in the

patients with RA by three different indices. Eight (32%) of the patients

with RA had hypochlorhydria or achlorhydria. The acid secretory capacity

was determined with pentagastrin stimulation. A modified Crosby capsule

was used to obtain biopsy specimens and samples of intestinal fluid from

the proximal jejunum; aerobic and anaerobic microbial cultivation of

mucosal specimens/intestinal fluid was carried out, and gas production

and microflora associated characteristics in jejunal fluid were

determined. Additionally, a bile acid deconjugation breath test was

performed. RESULTS--Subjects with at least one of the following findings

were considered to have bacterial overgrowth: positive bile acid

deconjugation test; growth of Enterobacteriaceae; positive gas

production; or low tryptic activity. By these criteria half of the

patients with RA with hypochlorhydria or achlorhydria and half of the

achlorhydric controls had bacterial overgrowth. Thirty five per cent of

the patients with RA with normal gastric acid secretion had bacterial

overgrowth compared with none of the normal controls. Disease activity

indices and rheumatoid factor titres were significantly higher in

patients with RA with bacterial overgrowth than in those without.

CONCLUSIONS--A high frequency of small intestinal bacterial overgrowth

was found in patients with RA; it was associated with a high disease

activity and observed in patients with hypochlorhydria or achlorhydria

and in those with normal acid secretion.

MeSH Terms:

* Achlorhydria/microbiology

* Adult

* Arthritis, Rheumatoid/microbiology*

* Arthritis, Rheumatoid/metabolism

* Bacteria/metabolism

* Bile Acids and Salts/metabolism

* Breath Tests

* Comparative Study

* Enterobacteriaceae/growth & development*

* Female

* Gastric Acidity Determination

* Human

* Intestinal Mucosa/microbiology

* Intestine, Small/microbiology*

* Male

* Middle Age

* Support, Non-U.S. Gov't

Substances:

* Bile Acids and Salts

PMID: 8346978 [PubMed - indexed for MEDLINE]

ed - indexed for MEDLINE]