Abnormal fecal flora in a patient with short bowel syndrome. An in vitro study on effect of pH on D-lactic acid production

Dig Dis Sci. 1996 Aug;41(8):1649-52. doi: 10.1007/BF02087915.


D-Lactic acidosis associated with encephalopathy is a clinical condition that occurs in patients with short bowel syndrome. We studied the fecal flora and the composition of fecal water of a child who developed this unusual disorder. Bacteriological studies showed that the patient's stool contained a marked predominance of gram-positive anaerobes. Two strains were identified, Lactobacillus plantarum and Lactobacillus salivarius, as the main bacteria isolated. Fecal water showed pH 4.8 and total lactic acid (sum of L- and D-lactic acids) was the principal organic anion found in the feces. We also incubated the patient's stool in a continuous culture with a view to determining the effect of the pH on the production of volatile fatty acids (VFA) and L- and D-lactic acids. The culture was maintained at pH 5.0, 5.5, 6.0, and 6.5 for four consecutive periods of four days each. We then studied the culture for a further four days at pH 5.0 once again. This study showed that with the progressive rise of the pH from 5.0 to 6.5 L- and D-lactic acids decreased and VFA production increased. D-Lactic acid formation was inhibited at pH 6.5, but when the culture was returned to pH 5.0, it increased to a high level again. These results suggest that the pH plays an important role in the ecological changes in the colonic bacteria that result in D-lactic acid production.

MeSH terms

  • Bacteria, Anaerobic / isolation & purification
  • Brain Diseases, Metabolic / etiology
  • Brain Diseases, Metabolic / metabolism
  • Child
  • Fatty Acids, Volatile / metabolism
  • Feces / chemistry
  • Feces / microbiology*
  • Humans
  • Hydrogen-Ion Concentration
  • Lactates / metabolism*
  • Lactic Acid
  • Lactobacillus / isolation & purification
  • Male
  • Short Bowel Syndrome / complications
  • Short Bowel Syndrome / microbiology*


  • Fatty Acids, Volatile
  • Lactates
  • Lactic Acid