4.4 Article

Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes

Journal

SURGERY FOR OBESITY AND RELATED DISEASES
Volume 17, Issue 3, Pages 585-594

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.soard.2020.10.021

Keywords

Calprotectin; Intestinal inflammation; Roux-en-Y gastric bypass surgery; Short-chain fatty acids; Type 2 diabetes

Categories

Funding

  1. Yrjo Jahnsson Foundation [20197174]
  2. Academy of Finland [275614, 316664, 315568]
  3. Novo Nordisk Foundation [NNF OC0013659]
  4. Signe and Ane Gyllenberg Foundation
  5. Folkhalsan Research Foundation
  6. Helsinki University Central Hospital Research Funds
  7. Diabetes Research Foundation
  8. Paivikki and Sakari Sohlberg Foundation
  9. Finnish Foundation for Cardiovascular Research
  10. Northern Finland Healthcare Support Foundation
  11. Finnish Medical Foundation
  12. Wilhelm and Else Stockmann Foundation
  13. Academy of Finland (AKA) [315568] Funding Source: Academy of Finland (AKA)

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RYGB surgery is effective in reducing weight and improving cardiovascular risk factors, but it may also lead to increased inflammation in the gut, as shown by changes in fecal markers such as calprotectin and LPS concentration. Further research is needed to fully understand the clinical implications of these findings.
Background: Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity, which improves cardiovascular health and reduces the risk of premature mortality. However, some reports have suggested that RYGB may predispose patients to adverse health outcomes, such as inflammatory bowel disease (IBD) and colorectal cancer. Objectives: The present prospective study aimed to evaluate the impact of RYGB surgery on cardiovascular risk factors and gastrointestinal inflammation in individuals with and without type 2 diabetes (T2D). Setting: University hospital setting in Finland. Methods: Blood and fecal samples were collected at baseline and 6 months after surgery from 30 individuals, of which 16 had T2D and 14 were nondiabetics. There were also single study visits for 6 healthy reference patients. Changes in cardiovascular risk factors, serum cholesterol, and triglycerides were investigated before and after surgery. Fecal samples were analyzed for calprotectin, anti-Saccharomyces cerevisiae immunoglobulin A antibodies (ASCA), active lipopolysaccharide (LPS) concentration, short-chain fatty acids (SCFAs), intestinal alkaline phosphatase activity, and methylglyoxal-hydro-imidazolone (MG-H1) protein adducts formation. Results: After RYGB, weight decreased on average 221.6% (-27.2 +/- 7.8 kg), excess weight loss averaged 51%, and there were improvements in cardiovascular risk factors. Fecal calprotectin levels (P < .001), active LPS concentration (P < .002), ASCA (P < .02), and MG-H1 (P < .02) values increased significantly, whereas fecal SCFAs, especially acetate (P < .002) and butyrate (P < .03) levels, were significantly lowered. Conclusion: The intestinal homeostasis is altered after RYGB, with several fecal markers suggesting increased inflammation; however, clinical significance of the detected changes is currently uncertain. As chronic inflammation may predispose patients to adverse health effects, our findings may have relevance for the suggested association between RYGB and increased risks of incident IBD and colorectal cancer. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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