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Small Intestinal Bacterial Overgrowth following Subtotal Colectomy for Colon Cancer

Background: Increasingly colon cancers are diagnosed early and treated surgically with excellent survival. However, after surgery, one third of patients report chronic unexplained gastrointestinal symptoms and poor quality of life.

Aim: To determine if small intestinal bacterial overgrowth could explain these symptoms is unclear.

Methods: We present a series of patients who developed chronic daily abdominal pain, gas, bloating and diarrhea after subtotal colectomy for colorectal cancer. Evaluations with CAT scan, endoscopies and empirical treatments were ineffective. We performed either a glucose breath test by administering 75 g glucose in 250 mL of water and collecting breath samples every 15 min for 2 hours and/or upper endoscopy with duodenal aspiration and culture for aerobic, anaerobic and fungal organisms. We found that all of these patients had small intestinal bacterial overgrowth. A two-week course of antibiotics led to complete resolution of symptoms.

Conclusion: Our cases illustrate that small intestinal bacterial overgrowth is a common yet poorly recognized problem in patients following subtotal colectomy. This condition can be readily identified with breath test and/or duodenal aspirates and culture. Prompt diagnosis and treatment of this condition can be very effective in ameliorating symptoms.


Jigar Bhagat W and Satish Rao SC*

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