Short bowel syndrome (SBS) is characterized by severe intestinal malabsorption following restrictive surgery. The objective of this study was to determine the functional contribution of SBS-microbiota after resection. It is well-known that SBS-microbiota displayed specific features with a prevalence of Lactobacillus, a low amount of some anaerobic microbes (Clostridium leptum) and an accumulation of fecal
lactate in some patients. Patients with jejuno-colonic anastomosis were stratified according to the presence of
lactate in their feces and, we observe that the
lactate-producing bacteria were predominant in the sub-group of patients accumulating fecal
lactate. One case of D-
encephalopathy crisis occurred when the D-
lactate isoform accumulated in the feces and plasma
bicarbonate levels decreased. The fecal sample at the time of the
encephalopathy was transferred to germ free rats (SBS-H rats). The SBS-H microbiota conserved some characteristics of the SBS donnor, predominated by
lactate-producing bacteria (mainly Lactobacillus), a low level of
lactate-consuming bacteria and undetectable C. leptum. However,
lactate did not accumulate in feces of recipient rats and the D-
encephalopathy was not reproduced in SBS-H rats. This suggests that the intact small bowel of the recipient rats protected them from
lactate accumulation and that D-
lactate encephalopathy can occur only in the absence of small intestine. After fecal transfer, we also show that gnotobiotic rats exhibited high levels of circulating
GLP-1 and
ghrelin, two
hormones that are known to be induced in SBS patients. Therefore, the microbiota of SBS is a reservoir of biological signals involved in post-resection adaptation.