目的:肥胖是小肠细菌过度生长(SIBO)的诱发因素。这项研究的目的是前瞻性评估SIBO的患病率及其临床,生物,以及Roux-en-Y胃旁路术(RYGB)手术之前和之后24个月的营养方面。
方法:在2016年至2020年间,51例患者(平均BMI为46.9kg/m2,66.7%的女性)需要RYGB。每个病人都接受了葡萄糖呼气测试,功能性消化体征的标准化审讯,饮食调查,验血,一张fecalogram,和人体测量数据收集。这些研究在手术前和RYGB后1、3、6、9、12、18和24个月进行。
结果:手术前,我们发现SIBO的患病率为17.6%(95%CI=[8.9%;31.4%]).在RYGB之后,在24个月的随访结束时,89.5%的患者发生SIBO。手术后肛门失禁似乎非常频繁,影响18.8%的人口在手术后18个月。尽管饮食脂质存在显着限制,但手术后我们观察到脂肪泻呈阳性,平均脂质为11.1g/24小时(p=0.0282)。
结论:我们的研究证实了文献中关于SIBO在重度肥胖患者中患病率的数据。第一次,我们观察到RYGB后SIBO突然出现,呼气试验中呼出的氢与脂肪代谢图上的脂质吸收不良之间存在相关性。因此,这些患者会出现脂肪性腹泻,经常大便失禁。
OBJECTIVE: 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.
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).
CONCLUSIONS: 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.