Abnormal Bile-Salt Patterns and Intestinal Bacterial Overgrowth Associated with Malabsorption

IN a variety of diseases involving the intestine, malabsorption has been attributed to the proliferation of bacteria in the small intestine and therapy directed against the organisms has reversed the malabsorption.1 2 3 4 5 When the organisms have been isolated, they have been identified as normal colonie flora or, less commonly, normal mouth and throat bacteria.4 8 The mechanism by which these otherwise nonpathogenic organisms might produce steatorrhea has not been defined. Recent attempts to explain this phenomenon have focused attention on alterations in bile-salt metabolism in these patients.6 , 7 Normally, bile salts are excreted into the duodenum entirely in the conjugated form,9 in which . . .