1. a-00021
Dr. Robert RUTLEDGE
Title of Paper: GLUTEN SENSITIVITY AS A CAUSE OF
SIGNIFICANT GASTROINTESTINAL SYMPTOMS AFTER MINI-
GASTRIC BYPASS
Nationality: United States of America
Position: Director
Department: Surgery
Organization: Center For Laparoscopic Obesity Surgery
Tel: +1-702 714 0011
E-mail: drr@clos.net

2. GLUTEN SENSITIVITY AS A
CAUSE OF SIGNIFICANT
GASTROINTESTINAL SYMPTOMS
AFTER MINI-GASTRIC BYPASS
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

3. Introduction
• Gluten sensitivity (GS), Celiac Disease, is
under-diagnosed in the population and its
frequency is increasing.
• Symptoms of gluten sensitivity include
bloating, abdominal discomfort or pain,
constipation and diarrhea

4. Foods Usually Made with Wheat
• Pasta • Cereal
• Couscous • Crackers
• Bread • Beer
• Flour Tortillas • Oats (see the
• Cookies section on oats
• Cakes below)
• Muffins • Gravy
• Pastries • Dressings
• Sauces

5. Introduction
• Post op Gastro-Intestinal (GI) symptoms,
similar to those seen in GS are common
after bariatric surgery and can be a difficult
diagnostic and therapeutic dilemma
(GERD, Abdominal bloating/pain,
Diarrhea/constipation, Nausea/Vomiting.)

6. Introduction
• Recently empirical trials of gluten free
diets ha successfully resolved GI
symptoms in several post Mini-Gastric
Bypass patients.
• The purpose of this study was to
survey MGB patients for GI symptoms
and for results of trials of gluten free
diets on these symptoms.

7. Methods:
• Survey of 1,595 Mini-Gastric Bypass
(MGB) patients to
• Assess results of the MGB,
• Presence of GI symptoms,
• Pre and post op GI and the
• Impact of a gluten free diet on GI
symptoms.

8. Results
• Few patients had heard of GS or Celiac
Disease.
• Only one person had been diagnosed
with GS pre or post op.
• Remarkably, 50.6% reported GS after
surgery.
• Of the patients reporting GS, 50% had
“gotten better by excluding gluten
foods from my diet after surgery.”

9. Conclusions:
• In spite of excellent weight loss and high
levels of patient satisfaction, as many as
half of all MGB patients report GI
symptoms similar to those of gluten
sensitivity.
• This high rate in bypass patients is much
higher than in the general population.

10. Conclusions
• The restructuring of the GI tract may
increase the risk of GS after bypass.
• Of the MGB patients reporting GS,
• Half of these patients reported that
excluding gluten from their diet
• Caused marked symptomatic
improvement.

11. Conclusions
• This is the first report of high levels of
GS after gastric bypass.
• GS is under diagnosed and it may often
be missed.
• If the findings of this report are
confirmed, this knowledge could guide
successful diagnosis and treatment of
these difficult patients.