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Obesity Surgery

, Volume 27, Issue 3, pp 599–605 | Cite as

Consequences of Small Intestinal Bacterial Overgrowth in Obese Patients Before and After Bariatric Surgery

  • Jean-Marc SabateEmail author
  • Muriel Coupaye
  • Séverine Ledoux
  • Benjamin Castel
  • Simon Msika
  • Benoit Coffin
  • Pauline Jouet
Original Contributions

Abstract

Background and Aims

Small intestinal bacterial overgrowth (SIBO) has been described in obese patients. The aim of this study was to prospectively evaluate the prevalence and consequences of SIBO in obese patients before and after bariatric surgery.

Patients and Methods

From October 2001 to July 2009, in obese patients referred for bariatric surgery (BMI >40 kg/m2 or >35 in association with comorbidities), a glucose hydrogen (H2) breath test (BT) was performed before and/or after either Roux-en-Y gastric bypass (RYGBP) or adjustable gastric banding (AGB) to assess the presence of SIBO. Weight loss and serum vitamin concentrations were measured after bariatric surgery while a multivitamin supplement was systematically given.

Results

Three hundred seventy-eight (mean ± SD) patients who performed a BT before and/or after surgery were included: before surgery, BT was positive in 15.4 % (55/357). After surgery, BT was positive in 10 % (2/20) of AGB and 40 % (26/65) of RYGBP (p < 0.001 compared to preoperative situation). After RYGBP, patients with positive BT had similar vitamin levels, a lower caloric intake (983 ± 337 vs. 1271 ± 404 kcal/day, p = 0.014) but a significant lower weight loss (29.7 ± 5.6 vs. 37.7 ± 12.9 kg, p = 0.002) and lower percent of total weight loss (25.6 ± 6.0 vs. 29.2 ± 6.9 %, p = 0.044).

Conclusion

In this study, SIBO is present in 15 % of obese patients before bariatric surgery. This prevalence does not increase after AGB while it rises up to 40 % of patients after RYGBP and it is associated with lower weight loss.

Keywords

Small intestinal bacterial overgrowth Microbiota Weight loss Vitamins Roux-en-Y gastric bypass 

Notes

Acknowledgments

This study was performed with a funding of the French National Society of Gastroenterology (Fond Aide à la Recherche, 2008 de la SNFGE).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Kopelman PG. Obesity as a medical problem. Nature. 2000;404:635–43.PubMedGoogle Scholar
  2. 2.
    Sabate 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;18:371–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Madrid AM, Poniachik J, Quera R, et al. Small intestinal clustered contractions and bacterial overgrowth: a frequent finding in obese patients. Dig Dis Sci. 2011;56:155–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Peterson LA, Cheskin LJ, Furtado M, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26:833–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Sanchez A, Rojas P, Basfi-Fer K, et al. Micronutrient deficiencies in morbidly obese women prior to bariatric surgery. Obes Surg. 2016;26:361–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19:56–65.CrossRefPubMedGoogle Scholar
  7. 7.
    Poitou BC, Ciangura C, Coupaye M, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33:13–24.CrossRefGoogle Scholar
  8. 8.
    Ledoux S, Calabrese D, Bogard C, et al. Long-term evolution of nutritional deficiencies after gastric bypass: an assessment according to compliance to medical care. Ann Surg. 2014;259:1104–10.CrossRefPubMedGoogle Scholar
  9. 9.
    Decker GA, DiBaise JK, Leighton JA, et al. Nausea, bloating and abdominal pain in the Roux-en-Y gastric bypass patient: more questions than answers. Obes Surg. 2007;17:1529–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Aron-Wisnewsky J, Dore J, Clement K. The importance of the gut microbiota after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2012;9:590–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Furet JP, Kong LC, Tap J, et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes. 2010;59:3049–57.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ledoux S, Msika S, Moussa F, et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg. 2006;16:1041–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Flourie B, Turk J, Lemann M, et al. Breath hydrogen in bacterial overgrowth. Gastroenterology. 1989;96:1225.CrossRefPubMedGoogle Scholar
  14. 14.
    Attar A, Flourie B, Rambaud JC, et al. Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. Gastroenterology. 1999;117:794–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Lupascu A, Gabrielli M, Lauritano EC, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157–60.CrossRefPubMedGoogle Scholar
  16. 16.
    Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24:42–55.CrossRefPubMedGoogle Scholar
  17. 17.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  18. 18.
    Msika S. Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic roux-en-Y (gastric short circuit. J Chir (Paris). 2002;139:214–7.Google Scholar
  19. 19.
    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. doi: 10.1111/j.1365-2036.2009.03951.x.:1-49.PubMedGoogle Scholar
  20. 20.
    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. 2016;51:277–80.CrossRefPubMedGoogle Scholar
  21. 21.
    Machado JD, Campos CS, Lopes Dah SC, et al. Intestinal bacterial overgrowth after Roux-en-Y gastric bypass. Obes Surg. 2008;18:139–43.CrossRefPubMedGoogle Scholar
  22. 22.
    Lakhani SV, Shah HN, Alexander K, et al. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res. 2008;28:293–8.CrossRefPubMedGoogle Scholar
  23. 23.
    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. doi: 10.1155/2015/102760.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bouchoucha M, Fysekidis M, Julia C, et al. Functional gastrointestinal disorders in obese patients. The importance of the enrollment source. Obes Surg. 2015;25:2143–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee WJ, Lee MH, PJ Y, et al. Gastro-intestinal quality of life after metabolic surgery for the treatment of type 2 diabetes mellitus. Obes Surg. 2015;25:1371–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Coupaye M, Riviere P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24:276–83.CrossRefPubMedGoogle Scholar
  28. 28.
    Bal BS, Finelli FC, Shope TR, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8:544–56.CrossRefPubMedGoogle Scholar
  29. 29.
    Aron-Wisnewsky J, Verger EO, Bounaix C, et al. Nutritional and protein deficiencies in the short term following both gastric bypass and gastric banding. PLoS One. 2016;11:e0149588.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Coupaye M, Sabate JM, Castel B, et al. Predictive factors of weight loss 1 year after laparoscopic gastric bypass in obese patients. Obes Surg 2010.Google Scholar
  31. 31.
    Turnbaugh PJ, Ley RE, Mahowald MA, et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444:1027–31.CrossRefPubMedGoogle Scholar
  32. 32.
    Cotillard A, Kennedy SP, Kong LC, et al. Dietary intervention impact on gut microbial gene richness. Nature. 2013;500:585–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Kong LC, Tap J, Aron-Wisnewsky J, et al. Gut microbiota after gastric bypass in human obesity: increased richness and associations of bacterial genera with adipose tissue genes. Am J Clin Nutr. 2013;98:16–24.CrossRefPubMedGoogle Scholar
  34. 34.
    Schwiertz A, Taras D, Schafer K, et al. Microbiota and SCFA in lean and overweight healthy subjects. Obesity (Silver Spring). 2010;18:190–5.CrossRefGoogle Scholar
  35. 35.
    Jeppesen PB, Mortensen PB. Colonic digestion and absorption of energy from carbohydrates and medium-chain fat in small bowel failure. JPEN J Parenter Enteral Nutr. 1999;23:S101–5.CrossRefPubMedGoogle Scholar
  36. 36.
    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;13:1198–204.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jean-Marc Sabate
    • 1
    • 4
    Email author
  • Muriel Coupaye
    • 2
  • Séverine Ledoux
    • 2
    • 4
  • Benjamin Castel
    • 3
  • Simon Msika
    • 3
    • 4
  • Benoit Coffin
    • 1
    • 4
  • Pauline Jouet
    • 1
  1. 1.Service de GastroentérologieAP-HP, Hôpital Louis Mourier, HUPNVSColombesFrance
  2. 2.Service d’Explorations Fonctionnelles, Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO)AP-HP, Hôpital Louis Mourier, HUPNVSColombesFrance
  3. 3.Service de Chirurgie digestive, Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO)AP-HP, Hôpital Louis Mourier, HUPNVSColombesFrance
  4. 4.Faculté de médecineDenis Diderot Paris 7ParisFrance

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