Skip to main content

Advertisement

SpringerLink
Log in

Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Bariatric surgery may cause undesirable gastrointestinal symptoms due to anatomical, functional and intestinal microbiota changes.

Purpose

The aim of this study was to evaluate the effect of probiotic supplementation on gastrointestinal symptoms and small intestine bacterial overgrowth (SIBO) in patients after Roux-en-Y gastric bypass (RYGB).

Materials and Methods

This is a prospective, randomized, double-blind, placebo-controlled trial. The patients were randomized into Control Group (CG) (n = 39) and Probiotic Group (PG) (n = 34). The PG received tablets containing Lactobacillus acidophilus and Bifidobaterium lactis (5 billion CFU/strain) for 90 days, and the CG received tablets with starch. Both the Gastric Symptom Rating Scale (GSRS) questionnaire and 3-day food record were answered before surgery (T0) and after 45 days (T1) and 90 days of surgery (T2). At T0 and T2, hydrogen breath test was used to verify the presence of SIBO.

Results

The prevalence of SIBO was similar among times, and the mean score of GSRS responses did not differ between groups at any time. However, PG patients reported less bloating compared to CG, more abdominal pain at T1 (which reduced at T2), more episodes of soft stools and nausea and less hunger pain after surgery, with no reports of urgent episodes to evacuate, even though they consumed more fat than the CG.

Conclusions

The supplementation of L. acidophilus and B. lactis is effective in reducing bloating, but without influencing the development of SIBO in the early postoperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Graph 1

Similar content being viewed by others

References

  1. Farias G, Thieme RD, Teixeira LM, et al. Good weight loss responders and poor weight loss responders after Roux-en-Y gastric bypass: clinical and nutritional profiles. Nutr Hosp. 2016;33(5):574. https://doi.org/10.20960/nh.574.

    Article  CAS  PubMed  Google Scholar 

  2. Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (sbcbm). Tratamento Cirúrgico: Técnicas Cirúrgicas, 2017. Portuguese. Available from: <https://www.sbcbm.org.br/tecnicas-cirurgicas/>

  3. Stenberg E, Szabo E, Ottosson J, et al. Health-related quality-of-life after laparoscopic gastric bypass surgery with or without closure of the mesenteric defects: a post-hoc analysis of data from a randomized clinical trial. Obes Surg. 2018 Jan;28(1):31–6. https://doi.org/10.1007/s11695-017-2798-z.

    Article  PubMed  Google Scholar 

  4. Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (sbcbm). Número de cirurgias bariátricas no Brasil aumenta 46,7%, 2018. Portuguese. Available from: https://www.sbcbm.org.br/numero-de-cirurgias-bariatricas-no-brasil-aumenta-467/

  5. Karbaschian MA, King WC, Devlin MJ, et al. Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up. Surg Obes Relat Dis. 2017;13(9):1562–71. https://doi.org/10.1016/j.soard.2017.03.028.

    Article  Google Scholar 

  6. Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204. https://doi.org/10.1007/s11605-009-0891-x.

    Article  PubMed  Google Scholar 

  7. Chen JC, Lee WJ, Tsou JJ, et al. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(1):57–61. https://doi.org/10.1016/j.soard.2015.07.010.

    Article  PubMed  Google Scholar 

  8. Gaon D, Garcia H, Winter L, et al. Effect of Lactobacillus and Saccharomyces boulardii on diarrhea. Medicina (Buenos Aires) 2003; 63: 293–298

  9. Waller PA, Gopal PK, Leyer GJ, et al. Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults. Scand J Gastroenterol. 2011;46:1057–64.

    Article  CAS  Google Scholar 

  10. De Castro Ma, et al. Manual de Críticas de Inquéritos Alimentares. São Paulo, 2013.

  11. Barifaldi LA, Abreu GA, Veiga GV; et al. Programa para registro de recordatório alimentar de 24 horas: aplicação no Estudo de Riscos cardiovasculares em Adolescentes Rev bras epidemiol, v.19, n.2, p.464–468, 2016. Portuguese. doi:https://doi.org/10.1590/1980-5497201600020020.

  12. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos Familiares. Tabela de Composição Nutricional dos Alimentos Consumidos no Brasil. Rio de Janeiro: IBGE; 2011.

  13. Andalib I, Shah H, Bal BS, et al. Breath hydrogen as a biomarker for glucose Malabsorption after Roux-en-Y gastric bypass surgery. Dis Markers. 2015;2015:102760–7. https://doi.org/10.1155/2015/102760.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gasbarrini A, Corazza GR, Gasbarrini G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009;29(Suppl 1):1–49. https://doi.org/10.1111/j.1365-2036.2009.03951.x.

    Article  PubMed  Google Scholar 

  15. Manterola DC, Urrutia VS, Otzen HT. Calidad de vida relacionada con salud: instrumentos de medición para valoración de resultados en cirugía digestiva alta. Rev Chil Cir. 2014;66(3):274–82. https://doi.org/10.4067/S0718-40262014000300016.

    Article  Google Scholar 

  16. Hogestol IK, Chahal-kummen M, Eribe I, et al. Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid. Obes Surg. 2017;27(6):1438–45. https://doi.org/10.1007/s11695-016-2499-z.

    Article  PubMed  Google Scholar 

  17. Wagner NRF, Zaparolli MR, Cruz MRR et al. Mudanças na microbiota intestinal e uso de probióticos no pós-operatório de bypass gástrico em y-de-roux e gastrectomia vertical sleeve: uma revisão integrativa. ABCD arq. bras. cir. dig. 2018; 31( 4 ): e1400. Portuguese. doi: https://doi.org/10.1590/0102-672020180001e1400.

  18. Mouillot T, Rhyman N, Gauthier C, et al. Study of small intestinal bacterial overgrowth in a cohort of patients with abdominal symptoms who underwent bariatric surgery. Obes Surg. 2020;30:2331–7. https://doi.org/10.1007/s11695-020-04477-5.

    Article  PubMed  Google Scholar 

  19. Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599–605.

    Article  Google Scholar 

  20. Sabaté JM, Jouet P, Harnois F, et al. High prevalence of small intestinal bacterial overgrowth in patients with morbid obesity: a contributor to severe hepatic steatosis. Obes Surg. 2008;18(4):371–7. https://doi.org/10.1007/s11695-007-9398-2.

    Article  PubMed  Google Scholar 

  21. Andrade HFA, Pedrosa W, Diniz MFHS, et al. Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients. Arch Endocrinol Metab. 2016;60(4):307–13. https://doi.org/10.1590/2359-3997000000149.

    Article  PubMed  Google Scholar 

  22. Montalto M, Gallo A, Santoro L, et al. Low-dose lactose in drugs neither increases breath hydrogen excretion nor causes gastrointestinal symptoms. Aliment Pharmacol Ther. 2008;28(8):1003–12. https://doi.org/10.1111/j.1365-2036.2008.03815.x.

    Article  CAS  PubMed  Google Scholar 

  23. Stefanidis D, Navarro F, Augenstein V, et al. Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc. 2012;26(12):3521–7. https://doi.org/10.1007/s00464-012-2380-7.

    Article  PubMed  Google Scholar 

  24. Serdar Y, Yilmaz K, Alptekin H, et al. Does digestive symptoms require esophago gastroscopy prior to bariatric procedure? Assessment of 6 years' experience. Ann Ital Chir. 2018;89:36–44.

    Google Scholar 

  25. Boerlage TCC, Westerink F, Van de Laa A, et al. Gastrointestinal symptoms before and after laparoscopic Roux-en-Y gastric bypass: a longitudinal assessment. Surg Obes Relat Dis. 2019;15:871–7.

    Article  Google Scholar 

  26. Pimentel M, Saad RJ, Long MD, et al. ACG clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol. 2020, 00:1–14. doi: https://doi.org/10.14309/ajg.0000000000000501.

  27. Labban SE, Safadi B, Olabi A. The effect of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on dietary intake, food preferences, and gastrointestinal symptoms in post-surgical morbidly obese Lebanese subjects: a cross-sectional pilot study. Obes Surg. 2015;25:2393–9. https://doi.org/10.1007/s11695-015-1713-8.

    Article  PubMed  Google Scholar 

  28. D’souza B, Slack T, Wong SW, et al. Randomized controlled trial of probiotics after colonoscopy. ANZ J Surg. 2015;87(9):65–9. https://doi.org/10.1111/ans.13225.

    Article  Google Scholar 

  29. Slavin J, Green H. Dietary fibre and satiety. Nutr Bull. 2007;32:32–42. https://doi.org/10.1111/j.1467-3010.2007.00603.x.

    Article  Google Scholar 

  30. Chatterjee S, Kar P, Das T, et al. Randomised placebo-controlled double blind multicentric trial on efficacy and safety of Lactobacillus acidophilus LA-5 ® and Bifidobacterium BB-12 ® for prevention of antibiotic-associated diarrhoea. J Assoc Physicians India. 2013;61(10):708–12.

    PubMed  Google Scholar 

  31. Forssten S, Malkanthi E, Wilson D, et al. Influence of a probiotic mixture on antibiotic induced microbiota disturbances. World J Gastroenterol. 2014;20(33):11878–85. https://doi.org/10.3748/wjg.v20.i33.11878.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Magro DO, Oliveira LM, Bernasconi I, et al. Effect of yogurt containing polydextrose Lactobacillus acidophilus NCFM and Bifidobacterium lactis HN019: a randomized, double-blind, controlled study in chronic constipation. Nutr J. 2014;13:75. https://doi.org/10.1186/1475-2891-13-75.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Viramontes-Horner D, Marquez-Sandoval F, Martín-del-Campo F, et al. Effect of a symbiotic gel (Lactobacillus acidophilus + Bifidobacterium lactis + inulin) on presence and severity of gastrointestinal symptoms in hemodialysis patients. J Ren Nutr. 2015;25(3):284–91. https://doi.org/10.1053/j.jrn.2014.09.008.

    Article  PubMed  Google Scholar 

  34. Mirghafourvand M, Rad AH, Charandabi SMA, et al. The effect of probiotic yogurt on constipation in pregnant women: a randomized controlled clinical trial. Iran Red Crescent Med J. 2016;18(11):e39870. https://doi.org/10.5812/ircmj.39870.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Borbély YM, Osterwalder A, Kroll D, et al. Diarrhea after bariatric procedures: diagnosis and therapy. World J Gastroenterol. 2017;23(26):4689–700. https://doi.org/10.3748/wjg.v23.i26.4689.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kopp-Hoolihan L. Prophylactic and therapeutic uses of probiotics: a review. J Am Diet Assoc. 2001;101(2):229–38; quiz 239-41. https://doi.org/10.1016/S0002-8223(01)00060-8.

    Article  CAS  PubMed  Google Scholar 

  37. Clements RH, Gonzalez QH, Foster A, et al. Gastrointestinal symptoms are more intense in morbidly obese patients and are improved with laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):610–4. https://doi.org/10.1381/096089203322190835.

    Article  PubMed  Google Scholar 

  38. Eslick GD. Gastrointestinal symptoms and obesity: a meta-analysis. Obes Rev. 2012;13(5):469–79. https://doi.org/10.1111/j.1467-789X.2011.00969.x.

    Article  CAS  PubMed  Google Scholar 

  39. Ierardi E, Losurdo G, Sorrentino C, et al. Macronutrient intakes in obese subjects with or without small intestinal bacterial overgrowth: an alimentary survey. Scand J Gastroenterol. Mar;51(3):277–80. https://doi.org/10.3109/00365521.2015.1086020.

  40. Looveren VR, Mandeville Y, Logghe P, et al. The effect of dumping on weight loss in conversion of failed restrictive surgery: a cross-sectional pilot study. Obes Surg. 2018;28:665–70. https://doi.org/10.1007/s11695-017-2906-0.

    Article  PubMed  Google Scholar 

  41. Zhong C, Qu C, Wang B, et al. Probiotics for preventing and treating small intestinal bacterial overgrowth a meta-analysis and systematic review of current evidence. J Clin Gastroenterol. 2017;51(4):300–11. https://doi.org/10.1097/MCG.0000000000000814.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research received financial support from the CAPES (Coordination for the Improvement of Higher Education Personnel). CAPES had no influence on the writing, submission, or any other part of research formulation.

Author information

Authors and Affiliations

  1. Nutrition Department (Nassif Clinic), Santa Casa de Misericórdia de Curitiba Hospital, Rua Bruno Filgueira, 485 - Batel, 80240-220,, Curitiba, Paraná, Brazil

    Nathalia Ramori Farinha Wagner

  2. Clinical Surgery Department, Federal University of Parana, Curitiba, Brazil

    Nathalia Ramori Farinha Wagner, Marilia Rizzon Zaparolli Ramos, Ligia de Oliveira Carlos & Antônio Carlos Ligocki Campos

  3. Positivo University, Curitiba, Brazil

    Marilia Rizzon Zaparolli Ramos

  4. Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil

    Magda Rosa Ramos da Cruz

  5. Department of Statistics, Federal University of Paraná, Curitiba, Brazil

    Cesar Augusto Taconeli

  6. ESALQ-USP, Curitiba, Brazil

    Cesar Augusto Taconeli

  7. Santa Casa de Misericórdia de Curitiba Hospital, Curitiba, Brazil

    Alcides José Branco Filho & Luis Sergio Nassif

  8. Nutrition Department, Federal University of Parana, Curitiba, Brazil

    Maria Eliana Madalozzo Schieferdecker

Authors
  1. Nathalia Ramori Farinha Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marilia Rizzon Zaparolli Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ligia de Oliveira Carlos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Magda Rosa Ramos da Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cesar Augusto Taconeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alcides José Branco Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luis Sergio Nassif
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Eliana Madalozzo Schieferdecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antônio Carlos Ligocki Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathalia Ramori Farinha Wagner.

Ethics declarations

This study was approved by the Research Ethics Committee of the Pontifical Catholic University of Paraná (PUCPR) under the number 2.810.276.

Conflict of Interest

The authors declare that they have no conflict of interest. The probiotics were donated by Bariatric Advantage (Aliso Viejo, CA, USA) and placebo and glucose by Dermatologica Pharmacy (Curitiba, Paraná, Brazil). The authors report non-financial support from Bariatric Advantage or Dermatologica Pharmacy. They had no influence on writing or interpreting the data.

Statement of Informed Consent

The authors declare that informed written consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wagner, N.R.F., Ramos, M.R.Z., de Oliveira Carlos, L. et al. Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. OBES SURG 31, 143–150 (2021). https://doi.org/10.1007/s11695-020-04900-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04900-x

Keywords

Search

Navigation