Small Intestinal Bacterial Overgrowth: Clinical Presentation in Patients with Roux-en-Y Gastric Bypass
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Small Intestinal Bacterial Overgrowth: Clinical Presentation in Patients with Roux-en-Y Gastric Bypass Russell D. Dolan 1 & Jason Baker 1 & Kimberly Harer 1 & Allen Lee 1 & William Hasler 1 & Richard Saad 1 & Allison R. Schulman 1 Received: 27 August 2020 / Revised: 30 September 2020 / Accepted: 6 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Small intestinal bacterial overgrowth (SIBO) is defined by an increased number of bacteria measured via exhaled hydrogen and/or methane gas following the ingestion of glucose. This condition is prevalent following abdominal surgery, including Roux-en-Y gastric bypass (RYGB), and associated with a variety of non-specific abdominal symptoms, often requiring an extensive diagnostic work-up. Aim To assess the frequency that individuals with RYGB anatomy are diagnosed with SIBO and if they are more likely to report specific gastrointestinal (GI) symptoms compared to individuals with native anatomy. Methods This large matched cohort study evaluated patients with GI symptoms who underwent a glucose breath test (GBT) for SIBO evaluation, utilizing 1:2 matching between RYGB and native anatomy. Patients with positive GBT were included in univariate and multivariate analyses to distinguish the presence of ten specific GI symptoms between RYGB and native anatomy. Results A total of 17,973 patients were included, where 271 patients with RYGB were matched to 573 patients with native anatomy that underwent GBT. Patients with RYGB anatomy and a positive GBT (199; 73.4%) as compared to those with native anatomy and a positive GBT (209; 36%) more often reported nausea, vomiting, bloating, and diarrhea. There were no differences between the two groups in the report of heartburn, regurgitation, chest pain, gas, or constipation. Conclusions SIBO is common in patients with RYGB and more commonly report nausea, vomiting, bloating, and diarrhea. The results of this study suggest that the report of these symptoms in RYGB should prompt early evaluation for SIBO. Keywords Roux-en-Y gastric bypass . Small intestinal bacterial overgrowth . Diarrhea . Nausea . Vomiting
Introduction Small intestinal bacterial overgrowth (SIBO) is defined by an increased number of bacteria in the small intestine prompting a variety of gastrointestinal symptoms [1]. SIBO is particularly prevalent following a variety of luminal abdominal surgeries, including Roux-en-Y gastric bypass (RYGB) [2, 3]. The modification of normal gut anatomy may induce bacterial stasis and subsequently precipitate SIBO and other nutritional deficiencies Guarantor of the article: Allison R. Schulman, MD, MPH * Allison R. Schulman [email protected] 1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI 48109-5362, USA
[4–6]. SIBO can either be diagnosed by the culturing of small bowel fluid obtained during upper endoscopy or non-invasively by t
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