To the Editor.—
In the article "Encephalopathy Following Jejunoileostomy" by Ayub et al (1981;246:970), the mechanism of the neurological syndrome was not clear. However, they stated, "As in hepatic coma, a substance or factor originating in the shortened intestine, in the colon, or in the bypassed intestine may alter cerebral function in these individuals." They also noted that this alteration occurred in the presence of apparently normal hepatic function. Their description of the syndrome is suggestive of hepatic encephalopathy.1 This is further supported by the fact that encephalopathy was responsive to broad-spectrum antibiotics, intravenous administration of dextrose water, or both, in their patients. Naturally, their patients did not receive a protein diet during this period. Unfortunately, many of their patients did not have liver biopsies or measurements of arterial blood ammonia, and none of them underwent the radiographic study of the portal venous system. Interestingly, reanastomosis in patients 5