Although a negative result in the technetium labeled (99mTc) hu- man serum albumin scintigraphy cannot exclude protein loos- ing enteropathy due to its variable sensitivity (66% to 96%),26 the cause of hypoproteinemia and hypoalbuminemia in our case favored SIBO itself. It is reported that SIBO and NASH can be improved when underlying cause is corrected, but there are some cases of NASH which does not resolve after surgical bypass correction.1 In our case, both NASH and SIBO improved dramatically after repair operation. In conclusion, we report a case of NASH caused by SIBO after jejunocolic bypass surgery, resolved dramatically after surgical correction, with a review of literature. CONFLICTS OF INTEREST No potential conflict of interest relevant to this article was reported. REFERENCES 1. Allard JP. Other disease associations with non-alcoholic fatty liver disease (NAFLD). Best Pract Res Clin Gastroenterol 2002;16:783- 795. 2. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med 1997;126:137-145. 3. Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol 2010;53:372-384. 4. Adams LA, Talwalkar JA. Diagnostic evaluation of nonalcoholic fatty liver disease. J Clin Gastroenterol 2006;40 Suppl 1:S34-S38. 5. Vuppalanchi R, Chalasani N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: selected practical issues in their evaluation and management. Hepatology 2009;49:306-317. 6. Tessier DJ, Eagon JC. Surgical management of morbid obesity. Curr Probl Surg 2008;45:68-137. 7. Deleña SA, Fechner RE, Brown H, Shelton EL Jr. Reversible fatty liver with fibrosis following jejunocolic shunt. South Med J 1970;63:399-402. 8. Ong JP, Younossi ZM. Epidemiology and natural history of NAFLD and NASH. Clin Liver Dis 2007;11:1-16. 9. Drenick EJ, Ament ME, Finegold SM, Corrodi P, Passaro E. Bypass enteropathy. Intestinal and systemic manifestations following small-bowel bypass. JAMA 1976;236:269-272. 10. Drenick EJ, Ament ME, Finegold SM, Passaro E Jr. Bypass enter- opathy: an inflammatory process in the excluded segment with systemic complications. Am J Clin Nutr 1977;30:76-89. Sung YK, et al: NASH Caused by Bypass Surgery 523 11. McGill DB, Humpherys SR, Baggenstoss AH, Dickson ER. Cirrhosis and death after jejunoileal shunt. Gastroenterology 1972;63:872- 877. 12. Reynolds TB. Medical complications of intestinal bypass surgery. Adv Intern Med 1978;23:47-59. 13. Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial over- growth, intestinal permeability, endotoxaemia, and tumour necro- sis factor alpha in the pathogenesis of non-alcoholic steatohepati- tis. Gut 2001;48:206-211. 14. Sajjad A, Mottershead M, Syn WK, Jones R, Smith S, Nwokolo CU. Ciprofloxacin suppresses bacterial overgrowth, increases fast- ing insulin but does not correct low acylated ghrelin concentra- tion in non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2005;22:291-299. 15. Farrell GC. Is bacterial ash the flash that ignites NASH? Gut 2001;48:148-149. 16. Wu WC, Zhao W, Li S. Small intestinal bacteria overgrowth de- creases small intestinal motility in the NASH rats. World J Gastro- enterol 2008;14:313-317. 17. Gasbarrini A, Lauritano EC, Gabrielli M, et al. Small intestinal bac- terial overgrowth: diagnosis and treatment. Dig Dis 2007;25:237- 240. 18. Singh VV, Toskes PP. Small bowel bacterial overgrowth: presenta- tion, diagnosis, and treatment. Curr Gastroenterol Rep 2003;5:365- 372. 19. Quigley EM, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin North Am 2010;24:943-959. 20. Fan X, Sellin JH. Review article. Small intestinal bacterial over- growth, bile acid malabsorption and gluten intolerance as pos- sible causes of chronic watery diarrhoea. Aliment Pharmacol Ther 2009;29:1069-1077. 21. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 2010;16:2978-2990. 22. Umar SB, DiBaise JK. Protein-losing enteropathy: case illustrations and clinical review. Am J Gastroenterol 2010;105:43-49. 23. Su J, Smith MB, Rerknimitr R, Morrow D. Small intestine bacterial overgrowth presenting as protein-losing enteropathy. Dig Dis Sci 1998;43:679-681. 24. Kerckhoffs AP, Visser MR, Samsom M, et al. Critical evaluation of diagnosing bacterial overgrowth in the proximal small intestine. J Clin Gastroenterol 2008;42:1095-1102. 25. Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut 2006;55:297-303. 26. Chiu NT, Lee BF, Hwang SJ, Chang JM, Liu GC, Yu HS. Protein- losing enteropathy: diagnosis with (99m)Tc-labeled human serum albumin scintigraphy. Radiology 2001;219:86-90.