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Obesity Surgery

, Volume 18, Issue 1, pp 139–143 | Cite as

Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass

  • Juliana Deh Carvalho Machado
  • Camila Scalassara Campos
  • Carolina Lopes Dah Silva
  • Vivian Miguel Marques Suen
  • Carla Barbosa Nonino-Borges
  • José Ernesto Dos Santos
  • Reginaldo Ceneviva
  • Júlio Sérgio Marchini
Case Report

Abstract

The aim of the present study was to report the occurrence of serious subnutrition, associated to intestinal bacterial overgrowth, in two patients submitted to bariatric surgery. Two female patients (body mass index, 49 and 50 kg/m2, respectively) were submitted to Y-en-Roux gastric bypass. The first patient evolved a 52% loss of body weight within 21 months after surgery; the other, a 34% loss of initial body weight within 15 months after surgery, results corresponding, respectively, to 62 and 45 kg weight losses. However, both patients reported asthenia, hair fallout, and edema, and one also reported diarrhea, but none was feverish. Their respective albuminemias were of 24 and 23 g/l. A respiratory hydrogen test suggested bacterial hyperproliferation. Thirty days after ciprofloxacin and tetracyclin treatments, they showed improved albumin levels and nutritional states, both confirmed by results of hydrogen breath tests. Bacterial overgrowth is an important complication that can compromise clinical evolution of patients submitted to intestinal surgery like gastroplasty with Y-Roux anastomosis. In cases of clinical suspicion or a confirmed diagnosis, adequate antibiotics, sometimes requiring to be cyclically repeated, should be administered.

Keywords

Poor absorption Bacterial overgrowth Bariatric surgery 

References

  1. 1.
    Steinbrook R. Surgery for severe obesity. N Eng J Med 2004;350:1076–9.Google Scholar
  2. 2.
    Sjöströn L, Lindroos A-K, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. The Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Eng J Med 2004;351:2683–93.CrossRefGoogle Scholar
  3. 3.
    Buchwald H. A bariatric surgery algorithm. Obes Surg 2002;12:733–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Costa ELO, Azevedo Júnior GM, Petroianu A. Influence of terminal ileum resection on hepatic fibrosis provoked by ligature of common bile duct in female rats. Rev Col Bras Cir 2006;33:19–23.CrossRefGoogle Scholar
  5. 5.
    Wiggs AJ, Roberts-Thomson IC, Dymock RC, McCarthy PJ, Grise RH, Cummins. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor α in the pathogenesis of non-alcoholic steatohepatitis. Gut 2001;48:206–11.CrossRefGoogle Scholar
  6. 6.
    Drenick EJ, Fister J, Johnson D. Hepatic steatosis after intestinal bypass-prevention and reversal by metronidazole, irrespective of protein-calorie malnutrition. Gastroenterology 1982;82:535–48.PubMedGoogle Scholar
  7. 7.
    Welkos SL, Toskes PP, Baer H. Importance of anaerobic bacteria in the cobalamin malabsorption of the experimental rat blind loop syndrome. Gastroenterology 1981;80:313–20.PubMedGoogle Scholar
  8. 8.
    Suter PM, Golner BB, Goldin BR, et al. Reversal of protein-bound vitamin B12 malabsorption with antibiotics in atrophic gastritis. Gastroenterology 1991;101:1039–45.PubMedGoogle Scholar
  9. 9.
    Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastrol Hepatol 2007;3:112–22.Google Scholar
  10. 10.
    Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 1988;95:982–8.PubMedGoogle Scholar
  11. 11.
    Walters B, Vanner SJ. Detection of bacterial overgrowth in IBS using the lactulose breath test: comparison with 14C-d-xylose and healthy controls. Am J Gastroenterol 2005;100:1566–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Wilcox CM, Waites KB, Smith PD. No relationship between gastric pH, small bowel bacterial colonization, and diarrhoea in HIV-1 infected patients. Gut 1999;44:101–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Di Stefano M, Miceli E, Missanelli A, et al. Absorbable vs. non-absorbable antibiotics in the treatment of small intestine bacterial overgrowth in patients with blind-loop syndrome. Aliment Pharmacol Ther 2005;21:85–992.CrossRefGoogle Scholar
  14. 14.
    Di Stefano M, Malservisi S, Veneto G, et al. Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2000;14:551–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Juliana Deh Carvalho Machado
    • 1
    • 4
  • Camila Scalassara Campos
    • 1
  • Carolina Lopes Dah Silva
    • 1
  • Vivian Miguel Marques Suen
    • 2
  • Carla Barbosa Nonino-Borges
    • 2
  • José Ernesto Dos Santos
    • 2
  • Reginaldo Ceneviva
    • 3
  • Júlio Sérgio Marchini
    • 2
  1. 1.Department of Internal MedicineHospital of the School of Medicine of Ribeirão PretoRibeirão PretoBrazil
  2. 2.Clinical Nutrition Division, Department of Clinical MedicineHospital of the School of Medicine of Ribeirão PretoRibeirão PretoBrazil
  3. 3.Department of SurgeryHospital of the School of Medicine of Ribeirão PretoRibeirão PretoBrazil
  4. 4.Departamento de Clínica MédicaHospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São PauloRibeirão PretoBrazil

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