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Summary Ten unoperated control patients and 18 patients with Billroth II subtotal gastrectomies, 11 without and 7 with steatorrhea, have been studied. Duodenal fluid in the control patients and afferent loop fluid in the postgastrectomy patients were subjected to quantitative bacterial cultures. Fat absorption was estimated by microscopic stool examinations, I 131 -triolein excretion studies, and, more recently, fat balance measurements. Bacterial counts in the unoperated control patients showed a mean of 18,940 colonies per cc. In the 11 postgastrectomy patients without evidence of steatorrhea the mean of the bacterial counts of afferent limb fluid was 625,210 colonies per cc. Streptococci predominated in 9 of these 11 patients. In 7 patients with steatorrhea, the mean colony count was 162,843,000 colonies per cc. The 2 patients with most severe steatorrhea had the highest bacterial counts—250,000,000 and 750,000,000 colonies per cc., respectively. In all steatorrheic patients the predominating organism was a Gram-negative bacillus, the flora generally resembling colonic flora in both quantity and quality. In the 2 most severely affected patients specific antibiotic therapy based on sensitivity determinations of cultured bacteria resulted in striking improvement in weight and fat absorption, which coincided with a return of the afferent limb flora to normal. Analysis of clinical data revealed that postgastrectomy steatorrhea tends to occur in patients with long, often antiperistaltic, poorly draining afferent limbs, where prolonged stasis permits the establishment of a resident bacterial flora. An analogy between postgastrectomy steatorrhea and the blind loop syndrome is suggested.

Treatment of newborn rats with capsaicin (0.16 mmol/kg) is known to cause a permanent degeneration of mainly unmyelinated afferent neurons. In this study, postoperative ileus and ileus produced by peritoneal irritation with iodine were investigated in adult rats treated with capsaicin as neonates. It was found that in capsaicin-treated rats both forms of ileus, measured as inhibition of gastrointestinal transit, were significantly reduced as compared with vehicle-treated control animals. Adrenoceptor blockade in untreated rats reduced the ileus in response to peritoneal irritation to approximately the same degree as treatment with capsaicin. In capsaicin-treated rats, however, adrenoceptor blockade was without effect on the irritation-induced ileus. It is concluded that ileus in response to surgery or peritoneal irritation is due, at least in part, to activation of a neural reflex. The afferent limb of this reflex may be constituted by capsaicin-sensitive nerve fibers, whereas the efferent limb seems to involve sympathetic adrenergic neurons.