Total parenteral nutrition and the function of the intestinal microflora in Crohn's disease.

The effect of total parenteral nutrition (TPN) on the following six intestinal microflora-associated characteristics (MACs) was studied in patients with Crohn's disease: faecal tryptic activity (FTA), formation of coprostanol, urobilinogen, and deoxycholic acid, and degradation of mucin and beta-aspartylglycine. The FTA showed high levels before TPN, in accordance with previous findings, and decreased during TPN. Formation of coprostanol, urobilinogen, and deoxycholic acid was reduced in some patients, whereas no changes were found in the mucin and beta-aspartylglycine degradation.

Changes in gallstone morbidity in a community with decreasing frequency of cholecystectomies. A statistical study of the county of Stockholm, Sweden, 1969-1982.

From 1969 to 1982 there has been a continuous decrease in the cholecystectomy rate in the county of Stockholm, Sweden, from 265 per 100.000 population to 105. The change is greatest among young females. During the same period there has been a two-fold increase in gallbladder cancer. Although the total number of cases with common bile duct stones have decreased, they have increased in relation to the number of cholecystectomies. A similar trend is true for cases with and operations for acute cholecystitis. From 1970 to 1982 there has been a fairly constant number of cholecystographies and ultra sound scans of the biliary tract indicating that the diagnostic efforts have been unchanged, at least quantitatively. However, cases with positive diagnosis have decreased especially among young females. It is concluded that the decreased cholecystectomy rate in the county of Stockholm can be explained by a simultaneous decrease of the prevalence of gallstones, at least among the young, and a decrease of operations among those who have gallstones.

The physiological activity of human faecal flora evaluated by determination of germfree animal characteristics.

Germfree animals exhibit specific physiological signs which have been labeled germfree animal characteristics. Such characteristics have been used in animals and in man to evaluate the influence of antibiotics on the intestinal flora. In order to evaluate the feasibility of using germfree animal characteristics in the evaluation of the intestinal flora in man, out-patients and hospitalized patients without gastrointestinal disorders were investigated. All patients were on a normal diet and had not been treated with antibiotics the year prior to the study. Samples of faeces were obtained at routine controls or after 10-14 days in hospital and analyzed for coprostanol to cholesterol ratios, mucin and stercobilin contents and proteolytic and tryptic activity. No differences were observed between out-patients and hospitalized patients. The germfree animal characteristics was of the same order of magnitude in man as in conventional animals.

Ileal Crohn tissue and concomitant flora inoculated into germfree rats.

During the last decade, the presence of a transmissible agent in Crohn's disease has been disputed. Some authors have observed granulomatous changes in laboratory animals inoculated with Crohn tissue, while others have failed to do so. The reason for these differences in results might inter alia be the susceptibility of the recipient animals and/or the handling of the Crohn tissue. In the present study germfree rats, which are known ot be highly susceptible to microbial agents, were inoculated with ileal Crohn tissue with adjacent content. The Crohn tissue was handled in a way securing the least possible influence of oxygen on the anaerobic part of the flora. The animals were exsanguinated after 35 weeks. Specimens from the gastrointestinal tract and related organs were removed and examined histologically. In all 264 specimens from inoculated rats and 144 from untreated controls were examined. None of the inoculated germfree rats showed any patho-anatomical changes or other features related to Crohn's disease.