I emphasize again that this is just my guess, but the admission that Jobs had an unnamed procedure or operation gives me enough of a clue to what’s probably going on. Chances are, Jobs had either dumping syndrome or afferent loop syndrome. Of the two, given that he underwent a procedure, the latter strikes me as more likely, because surgery is much less common used to correct dumping. That’s because the troublesome symptoms of dumping can often be managed pretty well medically with octreotide and other drugs. The treatment of afferent limb syndrome (ALS), however, is almost always surgical. It is a mechanical problem and requires a mechanical solution. You’ve probably never heard of it unless you’ve been unfortunate enough to have it (or are a surgeon or gastroenterologist), but ALS is a potential complication after a certain type of gastrojejunostomy, which is when the stomach is connected to a loop of small bowel in an anastomosis. This leaves two “loops.” The efferent loop is the small bowel leading away from the anastomosis. The afferent loop is the loop proximal to the anastomosis, whose peristalsis runs towards the anastomosis. Bile and pancreatic juice dump into the afferent loop, as can be seen in the illustration above. If there is a mechanical problem with the afferent loop, it can result in symptoms soon after surgery or as long as many years later. That Jobs seems to be rather quickly looking worse nearly four years after his operation also suggests ALS.
