Microflora persistence on duodenojejunal flat or normal mucosa in time after a meal in children.

A pathogenic role for high numbers of bacteria in the small intestine had been suggested previously by bacterial counts on luminal aspirates, but these investigations were flawed by the sampling device "contamination" in the mouth and the changing nature of fluent intestinal content. A procedure was developed to sterilize the Watson biopsy capsule with HCl in the upper portion of the duodenum. Bacteria were counted in the mucosal homogenate of the first (diagnostic) duodenojejunal biopsy in 80 untreated celiac children, and in 46 children with irritable bowel syndrome (IBS) in a four-cell, controlled, randomized investigation. Persistence of bacteria on the mucosa for 20 h after the last meal was investigated in 62 subjects, and for 26 h after the last meal in 64 subjects. Bacteria, mainly streptococci and staphylococci, persisted at a concentration of 10(6) per gram of mucosa 20 h after the last meal. The number of bacteria per gram of mucosa was 24 times higher in all 62 children of the 20-h fast groups than in all 64 children of the 26-h fast groups (p < 0.001). The bacteria count in celiac children was 39 times higher in the 20-h fast group than in the 26-h one. This difference was significantly higher than the 11 times difference that was found on the normal mucosa between the 20- and 26-h fast IBS groups (p < 0.001), which was still significant. The number of bacteria on duodenojejunal mucosa depends on nutrient absorption and persists longer than the intermeal interval in these subjects.