Jejunoileal Bypass: Change in the Flora of the Small Intestine and Its Clinical Impact

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Abstract
Among the complications of jejunoilealbypassfor morbid obesityare proctitis, bypass enteritis, liverdisease, dermatitis,and arthritis, all of whichare thought to be connected with the intestinal microflora. Quantitative cultures from the small bowel of patients beforethe establishment of the bypassand from patientswithreoperations indicatecolonization of both the functioning smallbowel(bacterialcounts, 105.0–107.6 / ml) and of the bypassed loop (bacterialcounts, 106.4–109.7 / ml). Experiments in animals have shown that the presence of a bypassed loop, as compared with that of a resected bowel, is necessary for increased weight loss and for the development of liver disease. Clinical evidence for the impact of the intestinal microflora is based on the beneficial effect of antimicrobial agents, especially metronidazole, and on the demonstration of immunologic phenomena involving antigens of bacterial origin. Complications of jejunoileal bypass may serve to elucidatethe pathogenesis of other diseases.

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