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.
Poor absorption Bacterial overgrowth Bariatric surgery
This is a preview of subscription content, log in to check access.
Steinbrook R. Surgery for severe obesity. N Eng J Med 2004;350:1076–9.Google Scholar
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
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
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
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
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
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
Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastrol Hepatol 2007;3:112–22.Google Scholar
Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 1988;95:982–8.PubMedGoogle Scholar
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
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
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
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