Study of Small Intestinal Bacterial Overgrowth in a Cohort of Patients with Abdominal Symptoms Who Underwent Bariatric Surgery



Small intestinal bacterial overgrowth (SIBO) is a common complication of bariatric surgery. Digestive decontamination treatments with oral antibiotic therapy vary and are not codified. This retrospective study was conducted to analyse the characteristics of bariatric surgery patients who underwent a glucose breath test (GBT) and to analyse the effectiveness of the antibiotic decontamination therapy.

Materials and Methods

A total of 101 operated patients (Roux-en-Y bypass (RYB), omega bypass (ΩB) and sleeve gastrectomy (SG)) who underwent a GBT (75 g/250 mL) were included. Anthropometric data, symptoms of SIBO, type of surgery, use of proton pump inhibitors (PPIs) and antibiotic therapy were analysed. The effectiveness of the antibiotic treatment, defined by improvement of the symptoms, was evaluated during the follow-up.


Of the 85 women and 16 men included (48.5 ± 3.6 years old), 63 underwent RYB, 31 underwent ΩB and 7 underwent SG. The GBT was positive in 83% of the patients. A positive test was associated with age (p < 0.001), female sex (p < 0.01) and PPI use (p < 0.01), but there was no significant difference according to the type of surgery. Sixty-one percent of patients treated with gentamicin/metronidazole sequential antibiotic therapy and 58% of patients treated with metronidazole alone achieved treatment efficacy (with no significant difference in efficacy between these treatments).


SIBO should be systematically considered in the context of abdominal symptoms in bariatric surgery patients, regardless the type of surgery, particularly in patients who are older or female and after PPI treatment. Digestive decontamination appears to be similar between gentamycin/metronidazole and metronidazole treatments.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Donaldson Jr RM. Small bowel bacterial overgrowth. Adv Intern Med. 1970;16:191–212.

    PubMed  Google Scholar 

  2. 2.

    Kirsch M. Bacterial overgrowth. Am J Gastroenterol. 1990;85(3):231–7.

    CAS  PubMed  Google Scholar 

  3. 3.

    Parlesak A, Klein B, Schecher K, et al. Prevalence of small bowel bacterial overgrowth and its association with nutrition intake in nonhospitalized older adults. J Am Geriatr Soc. 2003;51(6):768–73.

    Article  Google Scholar 

  4. 4.

    Khoshini R, Dai SC, Lezcano S, et al. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008;53(6):1443–54.

    Article  Google Scholar 

  5. 5.

    Rezaie A, Buresi M, Lembo A, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol. 2017;112(5):775–84.

    CAS  Article  Google Scholar 

  6. 6.

    Quigley EMM. The spectrum of small intestinal bacterial overgrowth (SIBO). Curr Gastroenterol Rep. 2019;21(1):3.

    Article  Google Scholar 

  7. 7.

    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 

  8. 8.

    Nuzzo A, Maggiori L, Paugam-Burtz C, et al. Oral antibiotics reduce intestinal necrosis in acute mesenteric ischemia: a prospective cohort study. Am J Gastroenterol. 2019 Feb;114(2):348–51.

    Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    Cavin JB, Voitellier E, Cluzeaud F, et al. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats. Am J Physiol Gastrointest Liver Physiol. 2016;311(3):G492–500.

    Article  Google Scholar 

  11. 11.

    Bohm M, Siwiec RM, Wo JM. Diagnosis and management of small intestinal bacterial overgrowth. Nutr Clin Prac. 2013;28(3):289–99.

    Article  Google Scholar 

  12. 12.

    Thereaux J, Lesuffleur T, Czernichow S, et al. Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort. Surg Obes Relat Dis. 2017;13(6):951–9.

    Article  Google Scholar 

  13. 13.

    Revaiah PC, Kochhar R, Rana SV, et al. Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics. JGH open. 2018;2(2):47–53.

    Article  Google Scholar 

  14. 14.

    Lombardo L, Foti M, Ruggia O, et al. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010;8(6):504–8.

    Article  Google Scholar 

  15. 15.

    Lo WK, Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11(5):483–90.

    CAS  Article  Google Scholar 

  16. 16.

    Sharma N, Chau WY, Dobruskin L. Effect of long-term proton pump inhibitor therapy on hemoglobin and serum iron levels after sleeve gastrectomy. Surg Obes Relat Dis. 2019;15(10):1682–9.

    Article  Google Scholar 

  17. 17.

    Raj PP, Bhattacharya S, Misra S, et al. Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery. 2019;15(8):1261–9.

    Article  Google Scholar 

  18. 18.

    Newberry C, Tierney A, Pickett-Blakely O. Lactulose hydrogen breath test result is associated with age and gender. Biomed Res Int. 2016;2016:1064029.

    Article  Google Scholar 

  19. 19.

    Erdogan A, Rao SS, Gulley D, et al. Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil. 2015;27(4):481–9.

    CAS  Article  Google Scholar 

  20. 20.

    Shah SC, Day LW, Somsouk M, et al. Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2013;38(8):925–34.

    CAS  Article  Google Scholar 

  21. 21.

    Perez Aisa A, Garcia Gavilan MC, Alcaide Garcia J, et al. Small intestinal bacterial overgrowth is common after gastrectomy but with little impact on nutritional status. Gastroenterol Hepatol. 2019;42(1):1–10. El sobrecrecimiento bacteriano de intestino delgado es una entidad frecuente tras gastrectomia, pero con escasa relevancia en el estado nutricional

    Article  Google Scholar 

  22. 22.

    Lauritano EC, Gabrielli M, Scarpellini E, et al. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am J Gastroenterol. 2008;103(8):2031–5.

    Article  Google Scholar 

  23. 23.

    Bouhnik Y, Alain S, Attar A, et al. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol. 1999;94(5):1327–31.

    CAS  Article  Google Scholar 

  24. 24.

    Lauritano EC, Gabrielli M, Scarpellini E, et al. Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole. Eur Rev Med Pharmacol Sci. 2009;13(2):111–6.

    CAS  PubMed  Google Scholar 

  25. 25.

    Melchior C, Gourcerol G, Bridoux V, et al. Efficacy of antibiotherapy for treating flatus incontinence associated with small intestinal bacterial overgrowth: a pilot randomized trial. PLoS One. 2017;12(8):e0180835.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Thomas Mouillot.

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

Verify currency and authenticity via CrossMark

Cite this article

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 30, 2331–2337 (2020).

Download citation


  • Antibiotic therapy
  • Bariatric surgery
  • Glucose breath test
  • Obesity
  • Small intestinal bacterial overgrowth (SIBO)