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Prospective Monitoring of Small Intestinal Bacterial Overgrowth After Gastric Bypass: Clinical, Biological, and Gas Chromatographic Aspects

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Abstract

Background and Aims

Obesity is a predisposing factor for small intestinal bacterial overgrowth (SIBO). The aim of this study was to prospectively evaluate the prevalence of SIBO as well as its clinical, biological, and nutritional aspects before and up to 24 months after a Roux-en-Y gastric bypass (RYGB) surgery.

Patients and Methods

Fifty-one patients (mean BMI 46.9 kg/m2, 66.7% women) requesting RYGB were included between 2016 and 2020. Each patient underwent a glucose breath test, a standardized interrogation on functional digestive signs, a dietary survey, a blood test, a fecalogram, and anthropometric data gathering. These investigations were carried out before surgery and at 1, 3, 6, 9, 12, 18, and 24 months after RYGB.

Results

Before surgery, we found a prevalence of 17.6% of SIBO (95% CI = [8.9%; 31.4%]). After RYGB, at the end of 24 months of follow-up, 89.5% of patients developed SIBO. Anal incontinence appeared to be very frequent after surgery, affecting 18.8% of our population 18 months after surgery. We observed positive steatorrhea after surgery with an average of 11.1 g of lipids/24 h despite a significant limitation of dietary lipids (p = 0.0282).

Conclusion

Our study corroborates data in the literature on the prevalence of SIBO in severe obesity patients. For the first time, we observed the sudden appearance of SIBO after RYGB, with a correlation between exhaled hydrogen on a breath test and lipid malabsorption on the fecalogram. As a result, these patients develop fatty diarrhea, with frequent fecal incontinence.

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Data Availability

The data that support the findings of this study are available from the corresponding author, VF, upon reasonable request.

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Acknowledgements

SANTELYS association for financial support. Nutrition Team: Yoanne P., nurses, for breath testing. Véronique J. from GHAT research team and GHICL research team. Thank you Rasika for your help.

Funding

The Quitron chromatograph was paid for by a research grant from the SANTELYS association.

Author information

Authors and Affiliations

  1. Department of Nutrition, Arras General Hospital, Bd Besnier, 62000, Arras, France

    Vincent Florent, Solen Dennetiere, Bulle Gaudrat & Severine Andrieux

  2. Inserm, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, EGID, Lille Neuroscience & Cognition, UMR-S 1172, University of Lille, 59000, Lille, France

    Vincent Florent

  3. PSITEC Lab EA4072, University of Lille, 59000, Lille, France

    Bulle Gaudrat

  4. Department of Nutrition, Douai General Hospital, 59500, Douai, France

    Solen Dennetiere & Emmanuel Mulliez

  5. Delegation for Clinical Research and Innovation, Biostatistics Unit, Group of Hospitals of the Catholic Institute of Lille, 59000, Lille, France

    Laurene Norberciak

  6. Clinical Research Unit, Arras General Hospital, 62000, Arras, France

    Kathleen Jacquez

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  1. Vincent Florent
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Correspondence to Vincent Florent.

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Ethics Approval and Consent to Participate

All patients provided written informed consent to participate in the study, which was conducted in compliance with the tenets of the Declaration of Helsinki. The study complied with the MR001 reference methodology with regard to the French Data Protection Authority (CNIL). Informed consent was obtained from all individual participants included in the study. The trial protocol was reviewed and approved by a French National IRB (CPP Nord-Ouest I). 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.

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Key Points

- High prevalence of bacterial overgrowth in 89.5% of patients after a RYGB

- Positive correlation between exhaled hydrogen and lipid malabsorption

- Functional disorders induced by SIBO such as diarrhea with anal incontinence

- Clinical discrepancy between symptoms and breath test positivity

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Florent, V., Dennetiere, S., Gaudrat, B. et al. Prospective Monitoring of Small Intestinal Bacterial Overgrowth After Gastric Bypass: Clinical, Biological, and Gas Chromatographic Aspects. OBES SURG 34, 947–958 (2024). https://doi.org/10.1007/s11695-024-07080-0

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