title: Difficulty in walking 10 years after gastric surgery.
abstract: A 65-year-old gentleman presented with a history of abdominal distension and difficulty in walking 10 years after a Polya partial gastrectomy. Clinical history and neurological examination suggested an axonal sensory neuropathy. A computed tomographic scan of the abdomen showed a large afferent jejunal loop, and a hydrogen breath test confirmed small-bowel bacterial overgrowth secondary to the blind loop syndrome. Serological tests revealed low copper levels, which are a cause of a myeloneuropathy. The trace element deficiency occurred as a consequence of small-bowel bacterial overgrowth, and with antibiotic treatment of the bacterial overgrowth and copper supplementation his symptoms markedly improved.
authors.affiliation: Department of Digestive Diseases, Barts and the London School of Medicine, UK. heather.lewis@bartsandthelondon.nhs.uk
authors.forename: Heather I
authors.initials: HI
authors.lastname: Lewis
authors.forename: Arjune
authors.initials: A
authors.lastname: Sen
authors.forename: Charles O
authors.initials: CO
authors.lastname: Cockerell
authors.forename: Ralph R S H
authors.initials: RR
authors.lastname: Greaves
mesh_terms: D000368:Aged; D001765:Blind Loop Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D003300:Copper / Q000172:deficiency; D020234:Gait Ataxia / Q000209:etiology*; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D013118:Spinal Cord Diseases / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016138:Walking
chemical_list: D003300:Copper