Cargando…

Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity

OBJECTIVES: Despite the fact that the most effective treatment for morbid obesity today is gastric bypass surgery, some patients develop life-threatening nutritional complications associated with their weight loss. METHODS: Here we examine the influence of the altered anatomy and digestive physiolog...

Descripción completa

Detalles Bibliográficos
Autores principales: O’Keefe, Stephen J D, Rakitt, Tina, Ou, Junhai, El Hajj, Ihab I, Blaney, Elizabeth, Vipperla, Kishore, Holst, Jens-Jules, Rehlfeld, Jens
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587840/
https://www.ncbi.nlm.nih.gov/pubmed/28771242
http://dx.doi.org/10.1038/ctg.2017.39
_version_ 1783262072640897024
author O’Keefe, Stephen J D
Rakitt, Tina
Ou, Junhai
El Hajj, Ihab I
Blaney, Elizabeth
Vipperla, Kishore
Holst, Jens-Jules
Rehlfeld, Jens
author_facet O’Keefe, Stephen J D
Rakitt, Tina
Ou, Junhai
El Hajj, Ihab I
Blaney, Elizabeth
Vipperla, Kishore
Holst, Jens-Jules
Rehlfeld, Jens
author_sort O’Keefe, Stephen J D
collection PubMed
description OBJECTIVES: Despite the fact that the most effective treatment for morbid obesity today is gastric bypass surgery, some patients develop life-threatening nutritional complications associated with their weight loss. METHODS: Here we examine the influence of the altered anatomy and digestive physiology on pancreatic secretion and fat absorption. Thirteen post Roux-en-Y gastric bypass (RYGB) patients who had lost >100 lbs in the first year following surgery and who gave variable histories of gastrointestinal (GI) dysfunction, were selected for study. Food-stimulated pancreatic enzyme secretion and GI hormone responses were measured during 2 h perfusions of the Roux limb with a standard polymeric liquid formula diet and polyethylene glycol marker, with collections of secretions from the common channel distal to the anastomosis and blood testing. Fat absorption was then measured during a 72 h balance study when a normal diet was given containing ~100 g fat/d. RESULTS: Result showed that all patients had some fat malabsorption, but eight had coefficients of fat absorption <80%, indicative of steatorrhea. This was associated with significantly lower feed-stimulated secretion rates of trypsin, amylase, and lipase, and higher plasma peptide-YY concentrations compared with healthy controls. Five steatorrhea patients were subsequently treated with low quantities of pancreatic enzyme supplements for 3 months, and then retested. The supplements were well tolerated, and fat absorption improved in four of five patients accompanied by an increase in lipase secretion, but body weight increased in only three. Postprandial breath hydrogen concentrations were elevated with some improvement following enzyme supplementation suggesting persistent bacterial overgrowth and decreased colonic fermentation. CONCLUSIONS: Our investigations revealed a wide spectrum of gastrointestinal abnormalities, including fat malabsorption, impaired food stimulated pancreatic secretion, ileal brake stimulation, and bacterial overgrowth, in patients following RYGB which could be attributed to the breakdown of the normally highly orchestrated digestive anatomy and physiology.
format Online
Article
Text
id pubmed-5587840
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Nature Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-55878402017-12-01 Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity O’Keefe, Stephen J D Rakitt, Tina Ou, Junhai El Hajj, Ihab I Blaney, Elizabeth Vipperla, Kishore Holst, Jens-Jules Rehlfeld, Jens Clin Transl Gastroenterol Original Contributions OBJECTIVES: Despite the fact that the most effective treatment for morbid obesity today is gastric bypass surgery, some patients develop life-threatening nutritional complications associated with their weight loss. METHODS: Here we examine the influence of the altered anatomy and digestive physiology on pancreatic secretion and fat absorption. Thirteen post Roux-en-Y gastric bypass (RYGB) patients who had lost >100 lbs in the first year following surgery and who gave variable histories of gastrointestinal (GI) dysfunction, were selected for study. Food-stimulated pancreatic enzyme secretion and GI hormone responses were measured during 2 h perfusions of the Roux limb with a standard polymeric liquid formula diet and polyethylene glycol marker, with collections of secretions from the common channel distal to the anastomosis and blood testing. Fat absorption was then measured during a 72 h balance study when a normal diet was given containing ~100 g fat/d. RESULTS: Result showed that all patients had some fat malabsorption, but eight had coefficients of fat absorption <80%, indicative of steatorrhea. This was associated with significantly lower feed-stimulated secretion rates of trypsin, amylase, and lipase, and higher plasma peptide-YY concentrations compared with healthy controls. Five steatorrhea patients were subsequently treated with low quantities of pancreatic enzyme supplements for 3 months, and then retested. The supplements were well tolerated, and fat absorption improved in four of five patients accompanied by an increase in lipase secretion, but body weight increased in only three. Postprandial breath hydrogen concentrations were elevated with some improvement following enzyme supplementation suggesting persistent bacterial overgrowth and decreased colonic fermentation. CONCLUSIONS: Our investigations revealed a wide spectrum of gastrointestinal abnormalities, including fat malabsorption, impaired food stimulated pancreatic secretion, ileal brake stimulation, and bacterial overgrowth, in patients following RYGB which could be attributed to the breakdown of the normally highly orchestrated digestive anatomy and physiology. Nature Publishing Group 2017-08 2017-08-03 /pmc/articles/PMC5587840/ /pubmed/28771242 http://dx.doi.org/10.1038/ctg.2017.39 Text en Copyright © 2017 The Author(s) http://creativecommons.org/licenses/by-nc-sa/4.0/ Clinical and Translational Gastroenterology is an open-access journal published by Nature Publishing Group. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
spellingShingle Original Contributions
O’Keefe, Stephen J D
Rakitt, Tina
Ou, Junhai
El Hajj, Ihab I
Blaney, Elizabeth
Vipperla, Kishore
Holst, Jens-Jules
Rehlfeld, Jens
Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity
title Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity
title_full Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity
title_fullStr Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity
title_full_unstemmed Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity
title_short Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity
title_sort pancreatic and intestinal function post roux-en-y gastric bypass surgery for obesity
topic Original Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587840/
https://www.ncbi.nlm.nih.gov/pubmed/28771242
http://dx.doi.org/10.1038/ctg.2017.39
work_keys_str_mv AT okeefestephenjd pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT rakitttina pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT oujunhai pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT elhajjihabi pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT blaneyelizabeth pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT vipperlakishore pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT holstjensjules pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity
AT rehlfeldjens pancreaticandintestinalfunctionpostrouxenygastricbypasssurgeryforobesity