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Jejunal Flora: Function, Disorders & Treatment

The jejunal flora refers to the community of microorganisms living in the jejunum, the middle section of the small intestine. It plays a key role in digestion and gut health.

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Things worth knowing about "Jejunal flora"

The jejunal flora refers to the community of microorganisms living in the jejunum, the middle section of the small intestine. It plays a key role in digestion and gut health.

What is the Jejunal Flora?

The jejunal flora refers to the community of microorganisms – primarily bacteria – that inhabit the jejunum, the middle section of the small intestine located between the duodenum and the ileum. Compared to the large intestine, the number of microorganisms in the small intestine is significantly lower. Nevertheless, the jejunum harbors a characteristic microbial community that plays an important role in digestion and nutrient absorption.

Composition of the Jejunal Flora

In a healthy jejunum, bacterial counts are relatively low – typically between 10³ and 10⁵ colony-forming units per milliliter of intestinal content. The most commonly found bacterial groups include:

Streptococci (Streptococcus spp.)
Lactobacilli (Lactobacillus spp.)
Enterococci (Enterococcus spp.)
Occasional Staphylococci and other Gram-positive organisms

Several protective mechanisms maintain the low microbial count in the jejunum, including intestinal peristalsis, gastric acid, and antimicrobial secretions such as bile and pancreatic enzymes.

Functions of the Jejunal Flora

The microorganisms in the jejunum serve several important functions:

Supporting digestion: Certain bacteria assist in the fermentation of carbohydrates and the metabolism of nutrients.
Protective role: The normal flora prevents pathogenic (disease-causing) organisms from colonizing the intestinal mucosa.
Immune modulation: Bacteria in the small intestine interact with the gut-associated lymphoid tissue (GALT) and contribute to immune defense.
Vitamin production: Some bacteria produce vitamins such as vitamin K and certain B vitamins.

Disorders of the Jejunal Flora

The most common disorder affecting the jejunal flora is Small Intestinal Bacterial Overgrowth (SIBO), which involves an excessive proliferation of bacteria in the small intestine, leading to a variety of digestive complaints.

Causes of Bacterial Overgrowth

Reduced intestinal motility (e.g., in diabetes mellitus or following surgery)
Anatomical abnormalities of the intestine (e.g., diverticula, adhesions)
Low gastric acid production (hypochlorhydria or achlorhydria)
Conditions such as Crohn's disease or states following small bowel surgery
Immune deficiency

Symptoms of Bacterial Overgrowth

Bloating and flatulence
Diarrhea or constipation
Abdominal pain and cramps
Nutrient deficiencies (e.g., vitamin B12 deficiency, fat-soluble vitamin deficiencies)
Unintentional weight loss

Diagnosis

Assessment of the jejunal flora and diagnosis of small intestinal bacterial overgrowth can be performed using several methods:

Breath test: The glucose or lactulose breath test measures hydrogen and methane levels in exhaled air, which are elevated in cases of bacterial overgrowth.
Small intestinal aspiration: Fluid from the small intestine is collected via endoscopy and analyzed microbiologically (gold standard).
Blood tests: Detection of nutrient deficiencies as an indicator of impaired absorption.

Treatment

Treatment depends on the underlying cause and may include:

Antibiotics: For example, rifaximin, a poorly absorbed antibiotic that acts locally in the intestine.
Probiotics: May help restore a healthy gut flora and stabilize the jejunal microbiota.
Dietary adjustments: Nutritional modifications such as a low-FODMAP diet to reduce the availability of fermentable substrates for intestinal bacteria.
Treatment of the underlying condition: Such as improved blood sugar control in diabetes or surgical correction of anatomical abnormalities.

References

Ghoshal, U. C. et al.: Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and Liver, 2017.
World Gastroenterology Organisation (WGO): Small Intestinal Bacterial Overgrowth (SIBO) – Global Guidelines, 2020. Available at: www.worldgastroenterology.org
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Elsevier, current edition.

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