Top

Published in:

01-08-2017 | Review Article

Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review

Authors: Kamal K. Mahawar, Alistair J. Sharples

Published in: Obesity Surgery | Issue 8/2017

Abstract

Roux-en-Y gastric bypass (RYGB) is traditionally classified as a combined restrictive and malabsorptive operation. This notion of the operation influences its technical variations and revisions for patients who do not achieve significant weight loss after this surgery. There is an increasing body of literature suggesting a role for appetite suppression mediated by neuro-hormonal signals after RYGB. The purpose of this paper was to systematically review published English language scientific literature to determine the role of malabsorption towards weight loss achieved with RYGB. This review finds that there is little or no malabsorption of carbohydrates or protein after RYGB but there is some fat malabsorption. Overall, malabsorption makes a little (approximately 11.0% in the early period) overall contribution to weight loss after RYGB.

Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017; doi:10.1007/s11695-017-2666-x.

Welbourn R, Small P, Finlay I, Sarela A, Somers S, Mahawar K. Second National Bariatric Surgery Report. http://www.bomss.org.uk/wp-content/uploads/2014/04/Extract_from_the_NBSR_2014_Report.pdf Last Accessed on 22nd March ’ 2017

Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 2015;21(3):369–78.CrossRefPubMedPubMedCentral

O’Brien PE. Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol. 2010;25(8):1358–65.CrossRefPubMed

Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.CrossRefPubMed

Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.CrossRefPubMed

Pihlajamäki J, Grönlund S, Simonen M, et al. Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Metabolism. 2010;59(6):866–72.CrossRefPubMed

Carswell KA, Vincent RP, Belgaumkar AP, et al. The effect of bariatric surgery on intestinal absorption and transit time. Obes Surg. 2014;24(5):796–805.CrossRefPubMed

Odstrcil EA, Martinez JG, Santa Ana CA, et al. The contribution of malabsorption to the reduction in net energy absorption after long- limb Roux-en-Y gastric bypass. Am J Clin Nutr. 2010;92:704–13.CrossRefPubMed

10.

Moreland AM, Santa Ana CA, Asplin JR, et al. Steatorrhea and hyperoxaluria in severely obese patients before and after Roux-en-Y gastric bypass. Gastroenterology. 2017;152(5):1055–1067.e3.CrossRefPubMed

11.

Griffo E, Nosso G, Lupoli R, et al. Early improvement of postprandial lipemia after bariatric surgery in obese type 2 diabetic patients. Obes Surg. 2014;24(5):765–70.CrossRefPubMed

12.

Borbély Y, Plebani A, Kröll D, et al. Exocrine pancreatic insufficiency after Roux-en-Y gastric bypass. Surg Obes Relat dis. 2016;12(4):790–4.CrossRefPubMed

13.

Kumar R, Lieske JC, Collazo-Clavell ML, et al. Fat malabsorption and increased intestinal oxalate absorption are common after Roux- en-Y gastric bypass surgery. Surgery. 2011;149(5):654–61.CrossRefPubMedPubMedCentral

14.

Forbes R, Gasevic D, Watson EM, et al. Essential fatty acid plasma profiles following gastric bypass and adjusted gastric banding bariatric surgeries. Obes Surg. 2016;26(6):1237–46.CrossRefPubMed

15.

Bojsen-Møller KN, Jacobsen SH, Dirksen C, et al. Accelerated protein digestion and amino acid absorption after Roux-en-Y gastric bypass. Am J Clin Nutr. 2015;102(3):600–7.CrossRefPubMed

16.

Khoo CM, Muehlbauer MJ, Stevens RD, et al. Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction. Ann Surg. 2014;259(4):687–93.CrossRefPubMedPubMedCentral

17.

Laferrère B, Reilly D, Arias S, et al. Differential metabolic impact of gastric bypass surgery versus dietary intervention in obese diabetic subjects despite identical weight loss. Sci Transl Med. 2011;3(80):80re2.CrossRefPubMedPubMedCentral

18.

Andalib I, Shah H, Bal BS, et al. Breath hydrogen as a biomarker for glucose malabsorption after Roux-en-Y gastric bypass surgery. Dis Markers. 2015;2015:102760.CrossRefPubMedPubMedCentral

19.

Nguyen NQ, Debreceni TL, Bambrick JE, et al. Rapid gastric and intestinal transit is a major determinant of changes in blood glucose, intestinal hormones, glucose absorption and postprandial symptoms after gastric bypass. Obesity (Silver Spring). 2014;22(9):2003–9.CrossRef

20.

Nguyen NQ, Debreceni TL, Bambrick JE, et al. Upregulation of intestinal glucose transporters after Roux-en-Y gastric bypass to prevent carbohydrate malabsorption. Obesity (Silver Spring). 2014;22(10):2164–71.CrossRef

21.

Anderwald CH, Tura A, Promintzer-Schifferl M, et al. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery. Diabetes Care. 2012;35(12):2580–7.CrossRefPubMedPubMedCentral

22.

Jacobsen SH, Bojsen-Møller KN, Dirksen C, et al. Effects of gastric bypass surgery on glucose absorption and metabolism during a mixed meal in glucose-tolerant individuals. Diabetologia. 2013;56(10):2250–4.CrossRefPubMed

23.

Camastra S, Muscelli E, Gastaldelli A, et al. Long-term effects of bariatric surgery on meal disposal and β-cell function in diabetic and nondiabetic patients. Diabetes. 2013;62(11):3709–17.CrossRefPubMedPubMedCentral

24.

Falkén Y, Hellström PM, Holst JJ, et al. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96(7):2227–35.CrossRefPubMed

25.

Rodieux F, Giusti V, D’Alessio DA, et al. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008;16(2):298–305.CrossRef

26.

Wang G, Agenor K, Pizot J, et al. Accelerated gastric emptying but no carbohydrate malabsorption 1 year after gastric bypass surgery (GBP). Obes Surg. 2012;22(8):1263–7.CrossRefPubMedPubMedCentral

27.

Wilms B, Ernst B, Schmid SM, et al. Enhanced thermic effect of food after Roux-en-Y gastric bypass surgery. J Clin Endocrinol Metab. 2013;98(9):3776–84.CrossRefPubMed

28.

Savassi-Rocha AL, Diniz MT, Vilela EG, et al. Changes in intestinal permeability after Roux-en-Y gastric bypass. Obes Surg. 2014;24(2):184–90.CrossRefPubMed

29.

Caruana JA, Monte SV, Jacobs DM, et al. Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at <70% bypass. Surg Obes Relat dis. 2015;11(6):1248–55.CrossRefPubMed

30.

Manning S, Pucci A, Batterham RL. Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms. J Clin Invest. 2015;125(3):939–48.CrossRefPubMedPubMedCentral

31.

Bradley 3rd EL, Isaacs JT, Mazo JD, et al. Pathophysiology and significance of malabsorption after Roux-en-Y reconstruction. Surgery. 1977;81(6):684–91.PubMed

32.

Cosnes J, Lamy P, Beaugerie L, et al. Adaptive hyperphagia in patients with postsurgical malabsorption. Gastroenterology. 1990;99(6):1814–9.CrossRefPubMed

33.

le Roux CW, Bueter M. The physiology of altered eating behaviour after Roux-en-Y gastric bypass. Exp Physiol. 2014;99:1128–32.CrossRefPubMed

34.

Flancbaum L, Choban PS, Bradley LR, et al. Changes in measured resting energy expenditure after Roux-en-Y gastric bypass for clinically severe obesity. Surgery. 1997;122(5):943–9.CrossRefPubMed

35.

Borg CM, le Roux CW, Ghatei MA, et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93(2):210–5.CrossRefPubMed

36.

Savassi-Rocha AL, Diniz MT, Savassi-Rocha PR, et al. Influence of jejunoileal and common limb length on weight loss following Roux-en- Y gastric bypass. Obes Surg. 2008;18(11):1364–8.CrossRefPubMed

Title: Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review
Authors: Kamal K. Mahawar
Alistair J. Sharples
Publication date: 01-08-2017
Publisher: Springer US
Published in: Obesity Surgery / Issue 8/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-2762-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2017

Physical Function, Quality of Life, and Energy Expenditure During Activities of Daily Living in Obese, Post-Bariatric Surgery, and Healthy Subjects

The Band Must Not Be Abandoned.

A Biliopancreatic Limb of >150 cm with OAGB/MGB Is Ill-Advised

Five-Year Outcomes After Vertical Sleeve Gastrectomy for Severe Obesity: A Prospective Cohort Study

Effects of Duodenal-Jejunal Exclusion and New Bilio-Pancreatic Diversion on Blood Glucose in Rats with Type 2 Diabetes Mellitus

Does Bariatric Surgery Improve Assisted Reproductive Technology Outcomes in Obese Infertile Women?