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I am almost 2 yrs out from my gastric bypass, and I was told increased gas is a side effect. I understand that, but mine is so uncontrollable that it is affecting quality of life. It is especially bad and uncontrollable while working out. I do small group and semi-private circuit training, so I work in close proximity to others also working out. Sometimes the odor is not too bad, and sometimes it will overwhelm the whole area. It seems to get a little worse when I eat fruits and vegetables, but is bad no matter what I eat. Is there anything I can do to reduce this problem?

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Dear Deidrarezz,

It's not common for people to have foul smelling gas or diarrhea as a result of a short limb* gastric bypass. It's more common when the roux limb is quite long and the common channel is short such as after a duodenal switch or biliopancreatic diversion. I take it that you didn't have a gas problem before your bypass. Also you didn't mention whether or not you have any diarrhea.

There are a couple of causes of foul smelling gas that you might want to discuss with your PCP or your surgeon. One is fat malabsorption. If you are eating food that has too much fat for your intestine to handle, you may not absorb all of it, and your colon may produce extra gas. The same could occur if your pancreas is not producing enough fat digesting enzymes. Usually there is also diarrhea with fat malabsorption, but on occasion there is enough malabsorption to cause foul smelling gas, but not enough to cause significant diarrhea. The solution to fat malabsorption is to eat less fat or to use a pancreatic enzyme supplement like Creon or Pancrase on your food. These enzymes are by prescription, but are easy to use and don't spoil the flavor of your food.

Along the same lines is lactose intolerance. Some people can't handle milk products after gastric bypass or sleeve gastrectomy because the intestine is overwhelmed by the rapid presentation of milk or milk containing food. Before surgery the food sits in the stomach and is gradually released. After surgery the milk or milk containing food goes right into the intestine. Abdominal pain and diarrhea is common with lactose intolerence, but again are not always present. Treatment is avoidance of milk or milk products or use of Lactaid, the lactose enzyme supplement.

Another general cause of gas is overgrowth of bacteria in the bypassed portion of the stomach or sometimes in the small end tab of the roux limb that is left during surgery in one method of performing the gastrojejunostomy. Bacterial overgrowth can result in gas, and often causes abdominal pain and diarrhea. Treatment for bacterial overgrowth is an appropriate antibiotic.

Some people develop gas due to aerophagia or air swallowing. You would probably have had this before surgery, but I suppose you could have developed it afterwards due to a change in eating habits. Usually aerophagia is associated with painless abdominal distension. The only treatment for aerophagia that I'm aware of is behavioral.

Simethicone 160 mg four times a day, available over the counter, sometimes helps people pass gas less uncomfortably and less explosively.

If you see your doc about your problem, you might talk with him about culturing your stool for pathogens, ova and parasites, and c. difficile. The cultures would be most appropriate if you are having diarrhea in addition to gas.

Finally, you might consider trying a probiotic supplement such as an activated yogurt or one of the over the counter products.

I hope this answer has given you some ideas. I can't give you specific medical advice, because I don't know all the facts and you probably need some basic testing. With a little luck you and your doc should be able to make some progress.

Dr. Callery

* "Short limb" would be a Roux limb of 75-150 cm, afferent limb of 25-50 cm, and common channel of about 400 cm.

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Thank you for your answer. No, I don't have diarrhea on a normal basis, just the opposite. I am prone to constipation, which does make the gas worse, but it is bad either way. I will talk to my PCP next week and see what she says.  

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