Intestinal Bacteria — The Role They Play in Normal Physiology,Pathologic Physiology,and Infection

Anaerobic bacteria predominate in the normal human fecal flora, out-numbering aerobes at least 100 to one. The two most prevalent organisms are Bacteroides fragilis and Bifidobacterium. Ileostomy flora is, on the other hand, chiefly aerobic and the total count is lower (10⁸ per ml of fluid, compared to 10¹⁰ per gram for feces). In normal people, small bowel bacterial counts are generally 10⁵ per ml or less. The upper small bowel consists primarily of Gram-positive aerobes in small numbers. In the terminal ileum, counts are higher and aerobes and anaerobes are present in equal numbers. In the presence of acute obstruction and certain bowel stasis or other syndromes, the small bowel flora may become relatively profuse and fecal in type. The stomach normally has less than 10³ organisms per ml but counts are higher in gastric samples with pH above 4.0.Intestinal bacteria are important in such processes as conversion of bilirubin to urobilinogen, supply of vitamin K to the host, defense against infection, bile acid deconjugation and conversion, infections related to the bowel, the malabsorption of blind loop and other bacterial overgrowth syndromes, and hepatic coma.     

Endogenous Benzodiazepine Receptor Ligands in Human and Animal Hepatic Encephalopathy

The role of endogenous benzodiazepine receptor ligands in the pathogenesis of hepatic encephalopathy was studied in humans and in rat models of hepatic encephalopathy. Endogenous benzodiazepine ligands were extracted from rat brain and human CSF by acid treatment and purification by HPLC. Detection and partial characterization of these endogenous benzodiazepine ligands were carried out using both radioreceptor binding assays and radioimmunoassays with anti-benzodiazepine antibodies. Four different benzodiazepine receptor ligands were identified in human and rat tissue, two of which may be diazepam and desmethyldiazepam, based on elution profiles and anti-benzo-diazepine antibody reactivity. Human CSF and serum from patients with hepatic encephalopathy contained approximately 10 times more endogenous benzodiazepine receptor ligand than CSF from controls or nonencephalopathic patients with liver disease. The levels of brain benzodiazepine receptor ligand compounds were also increased approximately 10-fold in rats suffering from fulminant hepatic failure, but not in rats with portacaval shunts, a model of chronic hepatic disease. The increased concentrations of these substances could be behaviorally significant and may contribute to the pathogenesis of hepatic encephalopathy.