Small Intestinal Bacterial Overgrowth in Patients with Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass

Abstract

Background Small intestinal bacterial overgrowth (SIBO) is defined as an excessive growth and/or changed composition of bacteria in the small bowel. Obese patients are at increased risk of SIBO and related complications. The purpose of this study is to evaluate the incidence of SIBO after bariatric bypass procedures, connection between SIBO, symptoms, comorbidities, and liver pathology. Methods Patients underwent a hydrogen breath test with glucose substrate (25 g/200 ml of water). The demographic, anthropometric data, comorbidities, and symptoms were analysed with a questionnaire. In 45 patients, the NAFLD Activity Score was evaluated in liver biopsies. Results Glucose breath test was positive in 24/56 (43%) of patients and was associated with higher frequency of defecation (p = 0.022), lactose intolerance (p = 0.047), scleroderma (p = 0.042), irritable bowel syndrome (p = 0.018), and diabetes (p = 0.002). Mean NAFLD Activity Score in SIBO patients (n = 18) was 3.33 and 3.00 in non-SIBO patients (n = 27). In SIBO-positive cohort of patients, a statistically important trend in difference between NAS and difference to range value anti-Xa 4 h after subtherapeutic dose application was calculated. Conclusions The incidence of SIBO after bariatric surgery bypass procedures is alarmingly high (43%). The results of our study conclude that diagnosis cannot be set based on specific symptom and SIBO is related to reduced response to the application of LMWH. Mandatory SIBO screening and appropriate treatment would affect the clinical outcome of the underlying disease, improve it significantly, and prevent the development of its complications. Graphical abstract

Association between Gut Dysbiosis and the Occurrence of SIBO, LIBO, SIFO and IMO

“…In addition to the diseases mentioned above, the co-occurrence of SIBO has been identified in: non-alcoholic fatty liver disease [ 59 , 60 , 61 ], cirrhosis [ 62 ], chronic pancreatitis [ 63 ], obesity [ 64 ], cystic fibrosis [ 65 , 66 ], heart failure [ 67 , 68 ], hypothyroidism [ 69 ], Parkinson’s disease [ 70 , 71 , 72 ], depression [ 73 , 74 , 75 ], systemic sclerosis [ 76 , 77 ] chronic renal failure [ 78 , 79 ]. …”

Prevalence of Small Intestinal Bacterial Overgrowth Syndrome in Patients with Non-Alcoholic Fatty Liver Disease/Non-Alcoholic Steatohepatitis: A Cross-Sectional Study

“…Interesting experimental data from the field of obesity have suggested a potential correlation between gut microbiota and NAFLD/NASH development [ 13 , 14 , 15 , 16 ]. This correlation could be mediated by a variety of mechanisms including direct action of the bacteria or their by-products (e.g., LPS-endotoxin) on hepatic parenchyma, bacterial translocation due to the increased intestinal permeability, and redundant salvage energy by altered gut microbiota [ 17 , 18 ].…”

Small intestinal bacterial overgrowth: current update

“…Structural abnormalities from surgeries that create blind loops (e.g., Roux-en-Y gastric bypass, Billroth II), small bowel diverticula, or strictures allow for retained bowel contents and bacterial stasis, and thus predispose to overgrowth [28,29 ▪ ]. A recent study found the incidence of SIBO after bariatric surgery bypass procedures to be 43% based on glucose breath tests [30]. Resection of the ileocecal valve predisposes to SIBO because of retrograde movement of bacteria from the colon to the small intestine [31].…”