Reviewer's report 
 Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in patients with Title: 
malabsorption syndrome from the tropics 
Authors: 
Dr Ujjala Ghoshal ( ujjala@sgpgi.ac.in )
Uday CHAND Ghoshal ( ghoshal@sgpgi.ac.in )
Piyush Ranjan ( pranjan@sgpgi.ac.in )
Subhash R Naik ( ghoshal@sgpgi.ac.in )
Archana Ayyagari ( archana@sgpgi.ac.in )
 1  11 Feb 2003 Version: Date: 
 Terry Bolin Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Accept after discretionary revisions Advice on publication: 
The paper is interesting in that it documents the incidence of SIBO in a group of patients with 
malabsorption syndrome who have various diseases that might affect motility within the small bowel. 
It does not address, however, the very significant number of people in a developing country who 
have malabsorption syndrome without a demonstrable physical cause that might compromise 
motility. The high proportion of SIBO in the patients studied with malabsorption is interesting in that 
previous data have been conflicting and this paper tends to resolve some of that controversy, although there have been previous studies(1) that show that mucosal biopsy is the most reliable technique for validating SIBO. 
The authors indicate in their introduction that studies on the bacterial population contaminating the 
upper gut from developing countries are sparse and there is no study from developing countries on this issue. Such is not the case. Studies from Burma (2,3) were the first to establish the concept of 
SIBO as a cause of general malnutrition in a paediatric population. 
The demonstration of resistance to tetracycline and the high rates of sensitivity to quinolones is of 
significant clinical relevance as treatment until now has been problematic. 
Overall, the methodology is good and there are several points that would be of interest, particularly 
to research workers in the field. 
References 
1. Riordan SM, McIver CJ, Duncombe VM, Bolin TD. Bacteriological analysis of mucosal biopsies for detecting small-intestinal bacterial overgrowth. Scand J Gastroenterology 1995;30:681-685. 2. Pereira SP, Khin-Maung-U, Bolin TD, Duncombe VM, Nyunt-Nyunt-Wai, Myo-Khin, Linklater JM. 
A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese 
village children. J Pediatr Gastroenterol Nutr 1991;32-38. 
3. Khin-Maung-U, Bolin TD, Pereira SP, Duncombe VM, Myo-Khin, Nyunt-Nyunt-Wai, Linklater JM. Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese 
(Myanmar) village children. American Journal of Topical Medicine and Hygiene 1992;47:3:298-304. 
Competing interests: 
None declared. 
Reviewer's report 
 Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in patients with Title: 
malabsorption syndrome from the tropics 
Authors: 
Dr Ujjala Ghoshal ( ujjala@sgpgi.ac.in )
Uday CHAND Ghoshal ( ghoshal@sgpgi.ac.in )
Piyush Ranjan ( pranjan@sgpgi.ac.in )
Subhash R Naik ( ghoshal@sgpgi.ac.in )
Archana Ayyagari ( archana@sgpgi.ac.in )
 1  11 Feb 2003 Version: Date: 
 Terry Bolin Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Accept after discretionary revisions Advice on publication: 
The paper is interesting in that it documents the incidence of SIBO in a group of patients with 
malabsorption syndrome who have various diseases that might affect motility within the small bowel. 
It does not address, however, the very significant number of people in a developing country who 
have malabsorption syndrome without a demonstrable physical cause that might compromise 
motility. The high proportion of SIBO in the patients studied with malabsorption is interesting in that 
previous data have been conflicting and this paper tends to resolve some of that controversy, although there have been previous studies(1) that show that mucosal biopsy is the most reliable technique for validating SIBO. 
The authors indicate in their introduction that studies on the bacterial population contaminating the 
upper gut from developing countries are sparse and there is no study from developing countries on this issue. Such is not the case. Studies from Burma (2,3) were the first to establish the concept of 
SIBO as a cause of general malnutrition in a paediatric population. 
The demonstration of resistance to tetracycline and the high rates of sensitivity to quinolones is of 
significant clinical relevance as treatment until now has been problematic. 
Overall, the methodology is good and there are several points that would be of interest, particularly 
to research workers in the field. 
References 
1. Riordan SM, McIver CJ, Duncombe VM, Bolin TD. Bacteriological analysis of mucosal biopsies for detecting small-intestinal bacterial overgrowth. Scand J Gastroenterology 1995;30:681-685. 2. Pereira SP, Khin-Maung-U, Bolin TD, Duncombe VM, Nyunt-Nyunt-Wai, Myo-Khin, Linklater JM. 
A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese 
village children. J Pediatr Gastroenterol Nutr 1991;32-38. 
3. Khin-Maung-U, Bolin TD, Pereira SP, Duncombe VM, Myo-Khin, Nyunt-Nyunt-Wai, Linklater JM. Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese 
(Myanmar) village children. American Journal of Topical Medicine and Hygiene 1992;47:3:298-304. 
Competing interests: 
None declared. 
Please review this paper.
user
Reviewer's report 
 Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in patients with Title: 
malabsorption syndrome from the tropics 
Authors: 
Dr Ujjala Ghoshal ( ujjala@sgpgi.ac.in )
Uday CHAND Ghoshal ( ghoshal@sgpgi.ac.in )
Piyush Ranjan ( pranjan@sgpgi.ac.in )
Subhash R Naik ( ghoshal@sgpgi.ac.in )
Archana Ayyagari ( archana@sgpgi.ac.in )
 1  11 Feb 2003 Version: Date: 
 Terry Bolin Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Accept after discretionary revisions Advice on publication: 
The paper is interesting in that it documents the incidence of SIBO in a group of patients with 
malabsorption syndrome who have various diseases that might affect motility within the small bowel. 
It does not address, however, the very significant number of people in a developing country who 
have malabsorption syndrome without a demonstrable physical cause that might compromise 
motility. The high proportion of SIBO in the patients studied with malabsorption is interesting in that 
previous data have been conflicting and this paper tends to resolve some of that controversy, although there have been previous studies(1) that show that mucosal biopsy is the most reliable technique for validating SIBO. 
The authors indicate in their introduction that studies on the bacterial population contaminating the 
upper gut from developing countries are sparse and there is no study from developing countries on this issue. Such is not the case. Studies from Burma (2,3) were the first to establish the concept of 
SIBO as a cause of general malnutrition in a paediatric population. 
The demonstration of resistance to tetracycline and the high rates of sensitivity to quinolones is of 
significant clinical relevance as treatment until now has been problematic. 
Overall, the methodology is good and there are several points that would be of interest, particularly 
to research workers in the field. 
References 
1. Riordan SM, McIver CJ, Duncombe VM, Bolin TD. Bacteriological analysis of mucosal biopsies for detecting small-intestinal bacterial overgrowth. Scand J Gastroenterology 1995;30:681-685. 2. Pereira SP, Khin-Maung-U, Bolin TD, Duncombe VM, Nyunt-Nyunt-Wai, Myo-Khin, Linklater JM. 
A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese 
village children. J Pediatr Gastroenterol Nutr 1991;32-38. 
3. Khin-Maung-U, Bolin TD, Pereira SP, Duncombe VM, Myo-Khin, Nyunt-Nyunt-Wai, Linklater JM. Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese 
(Myanmar) village children. American Journal of Topical Medicine and Hygiene 1992;47:3:298-304. 
Competing interests: 
None declared. 
assistant