Bacterial Flora of the Small Bowel Before and After Bypass Procedure for Morbid Obesity

Abstract

The contents of the proximal jejunum and distal ileum were cultured quantitatively in eight patients who were undergoing intestinal bypass procedure for obesity. Five jejunal specimens were sterile, and three contained low counts of a predominantly aerobic flora. Ileal contents yielded variable but usually higher counts than in the jejunum, and there were similar numbers of anaerobes and aerobes. In three patients in whom a bypass was established, contents of the functioning small bowel showed counts of 10(5.0)-10(7.6) colony-forming units/ml. These counts exceeded the counts in the normal terminal ileum, and the flora qualitatively resembled that of feces. Four specimens from excluded loops revealed colonization with fecal organisms, and the counts ranged between 10(6.4) and 10(9.7) colony-forming units/ml. In jejunoileal bypass both the functioning small bowel and the excluded loop become colonized with colonic flora, a phenomenon that may contribute to some of the side effects of this procedure.

Immunometabolism of obesity and diabetes: microbiota link compartmentalized immunity in the gut to metabolic tissue inflammation

“…This work has been extended to the species level. Some of the most interesting association of microbiota changes during obesity and weight loss have also been associated with the remarkable weight loss and glucose-lowering effects of surgical gastric bypass [41,42]. Microbiota changes associated with RYGB (Roux-en-Y gastric bypass) can be observed as soon as 3 months after surgery, and, interestingly, increases in Faecalibacterium prausnitzii were negatively associated with markers of systemic inflammation such as CRP (C-reactive protein) and IL-6 [43].…”

Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS

“…On the contrary, in bypassed jejunum, up to 10 6 organisms/ml have been isolated, both aerobes and anaerobes. Bacteroides fragilis represents the most Review common pathogen among the anaerobes, while Escherichia coli predominates among the aerobes [15,16]. Gut injury and gut barrier failure have been considered to be contributors to the development of systemic inflammation and distant organ injury.…”

The Effect of Revision of the Intestinal Bypass on Post Intestinal Bypass Arthritis

“…Circulating immune complexes have been found in patients after intestinal bypass and may be important in the pathogenesis of the arthritis (5). It is well documented that the functioning small bowel and the excluded blind loop become colonized by fecal flora (6). The peripheral IgA levels of some patients who have had jejunoileal bypass surgery increase significantly above preoperative levels, possibly due to increased antigenic stimuli from colonic bacteria located in the small bowel blind loop (personal observation).…”

“…The arthritis-dermatitis associated with jejunoileal bypass surgery may develop as a result of bacterial overgrowth in the blind loop (6). Antibody formed in response to bacterial antigens may then form immune complexes which may deposit in target tissues, causing the arthritidermatitis syndrome.…”