American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition should be treated with empiric antibiotic therapy in patients with Roux-en-Y gastric bypass?

1. Peptic ulcers

2. Small intestinal bacterial overgrowth (SIBO)

3. Acute pancreatitis

4. Gastroesophageal reflux disease

The correct answer is: Small intestinal bacterial overgrowth (SIBO)

Empiric antibiotic therapy in patients with Roux-en-Y gastric bypass is particularly relevant for small intestinal bacterial overgrowth (SIBO). This condition is characterized by an abnormal increase in the number of bacteria in the small intestine, which can occur due to changes in gastrointestinal anatomy following the bypass surgery. The Roux-en-Y procedure alters the normal function and flow of the digestive tract, leading to impaired intestinal motility and an increased risk of bacterial overgrowth. Symptoms of SIBO can include bloating, diarrhea, malabsorption of nutrients, and weight loss. Given the potential for these complications and the need to swiftly address bacterial overgrowth to alleviate symptoms and improve absorption, empiric antibiotic therapy is recommended as a first-line treatment. This intervention helps to restore the normal balance of flora in the gut and can significantly improve the patient's condition. Other conditions listed, such as peptic ulcers, acute pancreatitis, and gastroesophageal reflux disease, do not have the same immediate indication for empiric antibiotic therapy. They typically require either specific treatments targeted at the underlying cause or supportive management strategies rather than broad-spectrum antibiotics as an initial approach. Thus, SIBO stands out as the condition that warrants such immediate intervention in the context of Roux