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  12 Mar 2003 Version: Date: 
 Robert M Craig Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Accept after discretionary revisions Advice on publication: 
Review. Ghoshal, et al. Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in 
patients with malabsorption syndrome from the tropics 
The authors obtained bacteriologic material from the jejunum in 50 patients with malabsorption 
syndrome and from 12 control patients, with a catheter device that they developed and described previously, inserted through a pediatric colonoscope. Greater that 105 colonies of bacteria were identified in 21 of the 50 patients, but in none of the 12 controls. 34 of the 50 patients had some 
growth. Some uncontrolled observations suggested that quinolone antibiotics were more effective 
than tetracycline. They contend that malabsorption itself may be responsible for small intestinal bacterial overgrowth. 
The study does add further information on small intestinal microbiology in malabsorption. Its major 
weakness is the failure to include the bacteriology for each malabsorptive entity. If all 7 patients with 
known small intestinal bacterial overgrowth and the majority of patients with tropical sprue had the 
significant bacterial cultures, > 105, then this does not give support to their contention that small 
intestinal bacterial overgrowth occurs more commonly in malabsorptive syndromes previously not 
known for this process. They should again be congratulated in their success in obtaining 100% collections of jejunal material for culture, an otherwise common problem for many other workers in this field. 
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  12 Mar 2003 Version: Date: 
 Robert M Craig Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Accept after discretionary revisions Advice on publication: 
Review. Ghoshal, et al. Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in 
patients with malabsorption syndrome from the tropics 
The authors obtained bacteriologic material from the jejunum in 50 patients with malabsorption 
syndrome and from 12 control patients, with a catheter device that they developed and described previously, inserted through a pediatric colonoscope. Greater that 105 colonies of bacteria were identified in 21 of the 50 patients, but in none of the 12 controls. 34 of the 50 patients had some 
growth. Some uncontrolled observations suggested that quinolone antibiotics were more effective 
than tetracycline. They contend that malabsorption itself may be responsible for small intestinal bacterial overgrowth. 
The study does add further information on small intestinal microbiology in malabsorption. Its major 
weakness is the failure to include the bacteriology for each malabsorptive entity. If all 7 patients with 
known small intestinal bacterial overgrowth and the majority of patients with tropical sprue had the 
significant bacterial cultures, > 105, then this does not give support to their contention that small 
intestinal bacterial overgrowth occurs more commonly in malabsorptive syndromes previously not 
known for this process. They should again be congratulated in their success in obtaining 100% collections of jejunal material for culture, an otherwise common problem for many other workers in this field. 
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  12 Mar 2003 Version: Date: 
 Robert M Craig Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Accept after discretionary revisions Advice on publication: 
Review. Ghoshal, et al. Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in 
patients with malabsorption syndrome from the tropics 
The authors obtained bacteriologic material from the jejunum in 50 patients with malabsorption 
syndrome and from 12 control patients, with a catheter device that they developed and described previously, inserted through a pediatric colonoscope. Greater that 105 colonies of bacteria were identified in 21 of the 50 patients, but in none of the 12 controls. 34 of the 50 patients had some 
growth. Some uncontrolled observations suggested that quinolone antibiotics were more effective 
than tetracycline. They contend that malabsorption itself may be responsible for small intestinal bacterial overgrowth. 
The study does add further information on small intestinal microbiology in malabsorption. Its major 
weakness is the failure to include the bacteriology for each malabsorptive entity. If all 7 patients with 
known small intestinal bacterial overgrowth and the majority of patients with tropical sprue had the 
significant bacterial cultures, > 105, then this does not give support to their contention that small 
intestinal bacterial overgrowth occurs more commonly in malabsorptive syndromes previously not 
known for this process. They should again be congratulated in their success in obtaining 100% collections of jejunal material for culture, an otherwise common problem for many other workers in this field. 
Competing interests: 
None declared. 
assistant