Velarde-Ruiz VJA, Baltazar-Alba I, Gómez-Hermosillo LF, Casillas- Moreno J, Ulloa-Ruiz FF, Godoy-Castro VM, Mercado-Jáuregui LA, Rangel-Orozco MF, Díaz-Aceves PE, Olvera-García VA, Guzmán-Lepe A, Quintero-Luce S, Ledesma-Vizcarra FM, Gil-López F, Remes-Troche JM

Language: Spanish
References: 12
Page: 131-136
PDF size: 570.70 Kb.

ABSTRACT

Introduction. One of the most common late manifestations after a laparoscopic Nissen fundoplication (LNF) are the symptoms related to gas management, which have been reported up to 40% after surgery. Some of these symptoms include the inability to burp and/or vomit, abdominal distension, postprandial fullness, and increased flatulence. Small intestine bacterial overgrowth (SIBO) is defined as the bacterial concentration higher than 103 colony forming units per ml (CFU/ml) in the small intestine.
Material and Methods. A descriptive cross-sectional study was performed, patients from the laparoscopic surgery service of the Hospital Civil "Dr. Juan I. Menchaca " who underwent LNF due to gastroesophageal reflux disease (GERD). The objectives of the study were to describe the frequency of SIBO in patients undergoing LNF and to know if patients with symptoms related to gas after LNF had SIBO. The diagnosis of SIBO was made by breath test with H expulsion using 75 g dextrose or 15 g lactulose (if diabetic) through the Gastrolyzer Bedfont^® device at 15 minute 2 intervals for 2 hours. Comparation with a control group of similar demographic characteristics was performed. The exclusion criteria included those patients who had more than 20 particles per million (ppm) of H in the baseline test and had taken an antibiotic one month prior to the test. 2 The severity of gastrointestinal symptoms and quality of life was evaluated according to the PAGI-SYM and PAGI-QoL questionnaires.
Results. In the control group (A), one came out as a a positive test (5.5%) while in the LNF group five were positive (B) (27.7%). Patients with LNF (group B) with a positive test for SIBO had a worse quality of life according to the PAGI-QoL questionnaire compared to those with a negative test. In this same group B, 72.2% of patients reported symptoms related to gas, of which 80% had a positive breath test.
Discussion. SIBO can be presented after a Nissen-type fundoplication, and manifest as symptoms related to gas, however, this does not imply that all patients with gas-related symptoms have SIBO. It is more frequent to find SIBO in fundoplicated patients, however a greater sample number to establish a meaningful association.

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