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Clinical features

Authoring team

Presentation is with diarrhoea or typical features of malabsorption. Bacteria - anaerobes, E. coli, Klebsiella - deconjugate bile salts, metabolise vitamin B12 and carbohydrate. Folate and fat soluble vitamins are not malabsorbed. The condition should be suspected in patients:

  • with a structural small intestinal abnormality
  • with sudden onset of diarrhoea in otherwise stable chronic disease, e.g. diabetes, Crohn's disease
  • malabsorption with low vitamin B12 and normal or raised folate

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