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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

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Abstract

Background

The purpose of this study is to determine the effects of posture and drink volume on gastric/pouch emptying (G/PE), intestinal transit, hormones, absorption, glycaemia, blood pressure and gastrointestinal (GI) symptoms after gastric bypass (Roux-en-Y gastric bypass (RYGB)).

Methods

Ten RYGB subjects were studied on four occasions in randomized order (sitting vs. supine posture; 50 vs. 150 ml of labelled water mixed with 3 g 3-O-methyl-d-glucose (3-OMG) and 50 g glucose). G/PE, caecal arrival time (CAT), blood glucose, plasma insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), peptide YY (PYY), 3-OMG, blood pressure, heart rate and GI symptoms were assessed over 240 min. Controls were ten volunteers with no medical condition or previous abdominal surgery, who were studied with the 150-ml drink in the sitting position.

Results

Compared to controls, PE (P < 0.001) and CAT (P < 0.001) were substantially more rapid in RYGB subjects. In RYGB, PE was more rapid in the sitting position (2.5 ± 0.7 vs. 16.6 ± 5.3 min, P = 0.02) and tends to be faster after 150 ml than the 50-ml drinks (9.5 ± 2.9 vs. 14.0 ± 3.5 min, P = 0.16). The sitting position and larger volume drinks were associated with greater releases of insulin, GLP-1 and PYY, as well as more hypotension (P < 0.01), tachycardia (P < 0.01) and postprandial symptoms (P < 0.001).

Conclusions

Pouch emptying, blood pressure and GI symptoms after RYGB are dependent on both posture and meal volume.

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Author Contribution

NN, CR, GW and MH designed the research. TD and CB conducted the research. MB provided the essential material. JW and NN analyzed the data. NN wrote the paper and has the primary responsibility for the final content. All authors read and approved the final manuscript.

Funding

This study was supported by funding from a National Health and Medical Research Council grant.

Conflict of Interest

No authors have any conflict of interest to declare

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia

    Nam Q. Nguyen, Tamara L. Debreceni, Carly M. Burgstad & Chris K. Rayner

  2. Discipline of Medicine, University of Adelaide, Adelaide, South Australia, 5000, Australia

    Nam Q. Nguyen, Judith M. Wishart, Chris K. Rayner, Gary A. Wittert & Michael Horowitz

  3. Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia

    Max Bellon

Authors
  1. Nam Q. Nguyen
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  2. Tamara L. Debreceni
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  3. Carly M. Burgstad
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  4. Judith M. Wishart
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  5. Max Bellon
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  6. Chris K. Rayner
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  7. Gary A. Wittert
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  8. Michael Horowitz
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Corresponding author

Correspondence to Nam Q. Nguyen.

Additional information

What is already known about the subject?

• In health, posture and meal volume exert little effect on gastric emptying (GE) of either solids or high-nutrient liquids.

• Roux-en-Y gastric bypass (RYGB) allows rapid transit of nutrients into the small intestine which may account for changes in gut hormone secretion and, potentially, “dumping syndrome”.

• The impact of posture and meal volume on GI transit, absorption and symptoms in these patients has not been investigated.

What does this research add?

• In RYGB subjects, the sitting posture was associated with more rapid pouch emptying, increased hypotension and postprandial symptoms.

• Compared to the effects of posture, those of drink volume were relatively minor.

• In RYGB subjects with “problematic dumping syndrome”, ingestion of small-volume meals in the supine or semi-supine posture may potentially minimize adverse haemodynamic changes and GI symptoms.

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Nguyen, N.Q., Debreceni, T.L., Burgstad, C.M. 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 25, 1392–1400 (2015). https://doi.org/10.1007/s11695-014-1531-4

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  • DOI: https://doi.org/10.1007/s11695-014-1531-4

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