Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 6/2021

01-06-2021 | Original Contributions

Gastrointestinal pH, Motility Patterns, and Transit Times After Roux-en-Y Gastric Bypass

Authors: Louise Ladebo, Pernille V. Pedersen, Grzegorz J. Pacyk, Jens Peter Kroustrup, Asbjørn M. Drewes, Christina Brock, Anne E. Olesen

Published in: Obesity Surgery | Issue 6/2021

Login to get access

Abstract

Background

Studies investigating the underlying pathophysiology are needed to help explain and understand the postoperative complications following Roux-en-Y gastric bypass (RYGB) surgery. This study aimed to characterize segmental gastrointestinal pH profiles, motility measures, and transit times in patients with RYGB.

Materials and Methods

Nineteen patients with RYGB underwent a standardized wireless motility capsule assessment. The oro-cecal segment was defined from capsule ingestion until the passage of the ileocecal junction. Segmental median pH, motility index, and transit time were determined for the oro-cecal and colonic segment as well as for the first and last hour of both these segments. For comparison to reference values, data from 17 healthy age- and gender-matched controls was used. A mixed effect model was used to describe differences between groups.

Results

Median pH was high in patients with RYGB during the first hour of the oro-cecal segment (6.45 ± 0.4 vs 3.65 ± 1.55 pH units for healthy controls; P < 0.001), as well as during the entire oro-cecal segment (6.97 ± 0.4 vs 5.51 ± 1.1 pH units; P < 0.001). The same was evident for the median motility index (152 ± 64 vs 35.8 ± 31.1 mmHg*sec/min; P < 0.001 and 130 ± 65.9 vs 89.1 ± 20 mmHg*sec/min; P < 0.012, respectively). Median motility index was low the first hour of the colon (55.2 ± 45.7 vs 122 ± 77.9 mmHg*sec/min; P < 0.002). Additionally, patients had short oro-cecal transit time (5.8 ± 1.6 vs 7.6 ± 1.4 h; P < 0.001) and long colonic transit time (29.4 ± 17.5 vs 19.6 ± 12.2 h; P = 0.048).

Conclusions

In patients with RYGB, the oro-cecal segment was characterized by an alkaline intraluminal environment, high motility activity, and short transit time. In contrast, colonic transit time was long.

Graphical abstract

Literature
1.
Tremmel M, Gerdtham U-G, Nilsson P, et al. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14:435.PubMedCentralCrossRef
2.
3.
Sundhedsstyrelsen. National Klinisk Retningslinje for fedmekirurgi. Vol. 150, InPharma. 2013 [cited 2019 Apr 10]. 9–10 p. Available from: http://​www.​sst.​dk.  Accessed 10 April 2020.
4.
Carlsson LMS, Sjöholm K, Jacobson P, et al. Life expectancy after bariatric surgery in the Swedish obese subjects study. N Engl J Med. 2020;383:1535–43.PubMedPubMedCentralCrossRef
5.
6.
7.
Angeles PC, Robertsen I, Seeberg LT, et al. The influence of bariatric surgery on oral drug bioavailability in patients with obesity: a systematic review. Obes Rev. 2019;20:1299–311.PubMedPubMedCentralCrossRef
8.
Hedberg J, Hedenström H, Sundbom M. Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: a novel use of the BRAVO™ system. Surg Endosc. 2011;25:2302–7.PubMedCrossRef
9.
Hedberg J, Hedenström H, Nilsson S, et al. Role of gastric acid in stomal ulcer after gastric bypass. Obes Surg. 2005;15:1375–8.PubMedCrossRef
10.
Mason EE, Munns JR, Kealey GP, et al. Effect of gastric bypass on gastric secretion. Surg Obes Relat Dis. 2005;1:155–60.PubMedCrossRef
11.
Dirksen C, Damgaard M, Bojsen-Møller KN, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil. 2013;25:346–e255.PubMedCrossRef
12.
Nguyen NQ, Debreceni TL, Burgstad CM, et al. Effects of fat and protein preloads on pouch emptying, intestinal transit, glycaemia, gut hormones, glucose absorption, blood pressure and gastrointestinal symptoms after Roux-en-Y gastric bypass. Obes Surg. 2016;26:77–84.PubMedCrossRef
13.
Carswell KA, Vincent RP, Belgaumkar AP, et al. The effect of bariatric surgery on intestinal absorption and transit time. Obes Surg. 2014;24:796–805.PubMedCrossRef
14.
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;22:1263–7.PubMedPubMedCentralCrossRef
15.
Morínigo R, Moizé V, Musri M, et al. Glucagon-Like Peptide-1, Peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006;91:1735–40.PubMedCrossRef
16.
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;96:2227–35.PubMedCrossRef
17.
Sarosiek I, Selover KH, Katz LA, et al. The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology. Aliment Pharmacol Ther. 2010;31:313–22.PubMed
18.
Wang YT, Mohammed SD, Farmer AD, et al. Regional gastrointestinal transit and pH studied in 215 healthy volunteers using the wireless motility capsule: influence of age, gender, study country and testing protocol. Aliment Pharmacol Ther. 2015;42:761–72.PubMedCrossRef
19.
Farmer AD, Pedersen AG, Brock B, et al. Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile. Diabetologia. 2017;60:709–18.PubMedCrossRef
20.
Farmer AD, Wegeberg A-ML, Brock B, et al. Regional gastrointestinal contractility parameters using the wireless motility capsule: inter-observer reproducibility and influence of age, gender and study country. Aliment Pharmacol Ther. 2018;47:391–400.PubMedCrossRef
21.
Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 3rd ed. Pearson/Prentice Hall: Upper Saddle River; 2009.
22.
Abuhelwa AY, Williams DB, Upton RN, et al. Food, gastrointestinal pH, and models of oral drug absorption. Eur J Pharm Biopharm. 2017;112:234–48.PubMedCrossRef
23.
Berg P, McCallum R. Dumping syndrome: a review of the current concepts of pathophysiology, diagnosis, and treatment. Dig Dis Sci. 2016;61:11–8.PubMedCrossRef
24.
25.
Camilleri M, Malagelada J-R. Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Investig. 1984;14:420–7.CrossRef
26.
Faria M, Pavin EJ, Parisi MCR, et al. Delayed small intestinal transit in patients with long-standing type 1 diabetes mellitus: investigation of the relationships with clinical features, gastric emptying, psychological distress, and nutritional parameters. Diabetes Technol Ther. 2013;15:32–8.PubMedCrossRef
27.
Nguyen NQ, Debreceni TL, Burgstad CM, et al. Effects of posture and meal volume on gastric emptying, intestinal transit, oral glucose tolerance, blood pressure and gastrointestinal symptoms after Roux-en-Y gastric bypass. Obes Surg. 2015;25:1392–400.PubMedCrossRef
28.
Näslund I, Beckman K-W. Gastric emptying rate after gastric bypass and gastroplasty. Scand J Gastroenterol. 1987;22:193–201.PubMedCrossRef
29.
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;56:2250–4.PubMedCrossRef
30.
Martinussen C, Bojsen-Møller KN, Dirksen C, et al. Augmented GLP-1 secretion as seen after gastric bypass may be obtained by delaying carbohydrate digestion. J Clin Endocrinol Metab. 2019;104:3233–44.PubMedCrossRef
31.
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;102:600–7.PubMedCrossRef
32.
33.
Hasler WL, Saad RJ, Rao SS, et al. Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS. Am J Physiol Gastrointest Liver Physiol. 2009;297:G1107–14.PubMedCrossRef
34.
Poulsen JL, Nilsson M, Brock C, et al. The impact of opioid treatment on regional gastrointestinal transit. J Neurogastroenterol Motil. 2016;22:282–91.PubMedPubMedCentralCrossRef
35.
Müller M, Canfora EE, Blaak EE. Gastrointestinal transit time, glucose homeostasis and metabolic health: modulation by dietary fibers. Nutrients. 2018;10:275.PubMedCentralCrossRef
36.
37.
Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18:1287–96.PubMedCrossRef
38.
Titus R, Kastenmeier A, Otterson MF. Consequences of gastrointestinal surgery on drug absorption. Nutr Clin Pract. 2013;28:429–36.PubMedCrossRef
39.
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;21:369–78.PubMedPubMedCentralCrossRef
40.
Bohlin J, Dahlin E, Dreja J, et al. Longer colonic transit time is associated with laxative and drug use, lifestyle factors, and symptoms of constipation. Acta Radiol Open. 2018;7:205846011880723.CrossRef
41.
Roager HM, Hansen LBS, Bahl MI, et al. Colonic transit time is related to bacterial metabolism and mucosal turnover in the gut. Nat Microbiol. 2016;1:16093.PubMedCrossRef
42.
Saad RJ. The wireless motility capsule: a one-stop shop for the evaluation of GI motility disorders. Curr Gastroenterol Rep. 2016;18:14.PubMedCrossRef
43.
Wright RA, Krinsky S, Fleeman C, et al. Gastric emptying and obesity. Gastroenterology. 1983;84:747–51.PubMedCrossRef
44.
Al Mushref M, Srinivasan S. Effect of high fat-diet and obesity on gastrointestinal motility. Ann Transl Med. 2013;1:14.PubMedPubMedCentral
45.
Vazquez Roque MI, Camilleri M, Stephens DA, et al. Gastric sensorimotor functions and hormone profile in normal weight, overweight, and obese people. Gastroenterology. 2006;131:1717–24.PubMedCrossRef
46.
Doran S, Jones KL, Andrews JM, et al. Effects of meal volume and posture on gastric emptying of solids and appetite. Am J Physiol. 1998;275:R1712–8.PubMed
47.
Velchik MG, Reynolds JC, Alavi A. The effect of meal energy content on gastric emptying. J Nucl Med. 1989;30:1106–10.PubMed
Metadata
Title
Gastrointestinal pH, Motility Patterns, and Transit Times After Roux-en-Y Gastric Bypass
Authors
Louise Ladebo
Pernille V. Pedersen
Grzegorz J. Pacyk
Jens Peter Kroustrup
Asbjørn M. Drewes
Christina Brock
Anne E. Olesen
Publication date
01-06-2021
Publisher
Springer US
Published in
Obesity Surgery / Issue 6/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-021-05308-x

Other articles of this Issue 6/2021

Obesity Surgery 6/2021 Go to the issue

Original Contributions

Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial)

Original Contributions

Analysis of the ‘Evaluation Indicators’ of an Enhanced Recovery After Bariatric Surgery Pathway in the First Six Months After Implementation

Original Contributions

Vitamin D in the Preoperative and Postoperative Periods of Bariatric Surgery

Original Contributions

Test Characteristics of Abdominal Computed Tomography for the Diagnosis of Gastro-gastric Fistula in Patients with Roux-en-Y Gastric Bypass

Original Contributions

Metabolic Surgery and Class 1 Obesity (< 35 kg/m2): a Prospective Study with Short-, Mid-, and Long-term Results Among Latinos

Letter to the Editor

Dignity and Respect: People-First Language with Regard to Obesity