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.
Similar content being viewed by others
References
Steinbrook R. Surgery for severe obesity. N Eng J Med 2004;350:1076–9.
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.
Buchwald H. A bariatric surgery algorithm. Obes Surg 2002;12:733–46.
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.
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.
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.
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.
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.
Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastrol Hepatol 2007;3:112–22.
Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 1988;95:982–8.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Deh Carvalho Machado, J., Campos, C.S., Lopes Dah Silva, C. et al. Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass. OBES SURG 18, 139–143 (2008). https://doi.org/10.1007/s11695-007-9365-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-007-9365-y