Expert: John Pilcher, MD - 4/4/2011

Question
I had Roux-En-Y in March 2005.  For the past  3 years I have been having chronic pain that began in my lower back and progressed to many joints - right wrist, left elbow, both feet, neck, thumb and index finger of right hand, backs of legs. I have seen many docs during this time with no answers until recently I put all the pieces together and came up with the Reactive Arthritis diagnosis.  I presented all the info to my Rheumatologist who concurred with me.  I believe it is a result of intestinal bacteria overgrowth as a result of the bypass.  Sulfasalazine has greatly improved my condition.  Have you seen these types of reactions before and do you have any suggestions as to how to treat them?  Neither my gastroenterologist nor my rheumatologist are sure of what to do.

Answer
Mimi,
I am familiar with the concept of intestinal overgrowth and the impact it may have on total body inflammation, but I have not seen the condition in my own patient population.

I do have a couple of ideas that I'd like you to discuss with your GI doctor, though my ideas are fairly basic and I'm surprised if he/she did not consider them.  It may be that your GI doctor has already thought through this and has different plans  In any case, the usual antibiotic treatment for intestinal bacterial overgrowth would be Flagyl, and it seems to be a good idea to follow that with a week of a probiotic.

Best wishes to you,

Dr JP