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Obesity Surgery
Published in: Obesity Surgery 5/2014

01-05-2014 | Original Contributions

The Effect of Bariatric Surgery on Intestinal Absorption and Transit Time

Authors: Kirstin A. Carswell, Royce P. Vincent, Ajay P. Belgaumkar, Roy A. Sherwood, Stephanie A. Amiel, Ameet G. Patel, Carel W. le Roux

Published in: Obesity Surgery | Issue 5/2014

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Abstract

Background

Bariatric surgical procedures are classified by their presumed mechanisms of action: restrictive, malabsorptive or a combination of both. However, this dogma is questionable and remains unproven. We investigated post-operative changes in nutrient absorption and transit time following bariatric surgery.

Methods

Participants were recruited into four groups: obese controls (body mass index (BMI) >30 kg/m2, n = 7), adjustable gastric banding (n = 6), Roux-en-Y gastric bypass (RYGB, n = 7) and biliopancreatic diversion with duodenal switch (DS, n = 5). Participants underwent sulphasalazine/sulphapyridine tests (oro-caecal transit time); fasting plasma citrulline (functional enterocyte mass); 3 days faecal collection for faecal elastase 1 (FE-1); calprotectin (FCp); faecal fatty acids (pancreatic exocrine function, gut inflammation and fat excretion, respectively); and 5 h d-xylose, l-rhamnose and lactulose test (intestinal absorption and permeability).

Results

Age and gender were not different but BMI differed between groups (p = 0.001). No difference in oro-caecal transit time (p = 0.935) or functional enterocyte mass (p = 0.819) was detected. FCp was elevated post-RYGB vs obese (p = 0.016) and FE-1 was reduced post-RYGB vs obese (p = 0.002). Faecal fat concentrations were increased post-DS vs obese (p = 0.038) and RYGB (p = 0.024) and were also higher post-RYGB vs obese (p = 0.033). Urinary excretion of d-xylose and l-rhamnose was not different between the groups; however, lactulose/rhamnose ratio was elevated post-DS vs other groups (all p < 0.02), suggesting increased intestinal permeability.

Conclusions

Following RYGB, there are surprisingly few abnormalities or indications of severe malabsorption of fats or sugars. Small bowel adaptation after bariatric surgery may be key to understanding the mechanisms responsible for the beneficial metabolic effects of these operations.
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Metadata
Title
The Effect of Bariatric Surgery on Intestinal Absorption and Transit Time
Authors
Kirstin A. Carswell
Royce P. Vincent
Ajay P. Belgaumkar
Roy A. Sherwood
Stephanie A. Amiel
Ameet G. Patel
Carel W. le Roux
Publication date
01-05-2014
Publisher
Springer US
Published in
Obesity Surgery / Issue 5/2014
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-1166-x

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