Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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.

    Article  PubMed Central  Google Scholar 

  2. World Health Organization. Obesity and overweight. 2018 [cited 2019 Aug 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 22 Aug 2020.

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dimitriadis GK, Randeva MS, Miras AD. Potential hormone mechanisms of bariatric surgery. Curr Obes Rep. 2017;6:253–65.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Seeras K, Lopez PP. Roux-en-Y gastric bypass chronic complications. StatPearls. 2019 [cited 2019 Jul 16];Available from: http://www.ncbi.nlm.nih.gov/pubmed/30137773.  Accessed 16 July 2020.

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  10. Mason EE, Munns JR, Kealey GP, et al. Effect of gastric bypass on gastric secretion. Surg Obes Relat Dis. 2005;1:155–60.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  21. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 3rd ed. Pearson/Prentice Hall: Upper Saddle River; 2009.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  24. Megan D. What is hypochlorhydria. Healthline Media. 2018 [cited 2019 Oct 2]. Available from: https://www.healthline.com/health/hypochlorhydria.  Accessed 2 Oct 2020.

  25. Camilleri M, Malagelada J-R. Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Investig. 1984;14:420–7.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  28. Näslund I, Beckman K-W. Gastric emptying rate after gastric bypass and gastroplasty. Scand J Gastroenterol. 1987;22:193–201.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  32. Farmer AD, Mohammed SD, Dukes GE, et al. Caecal pH is a biomarker of excessive colonic fermentation. World J Gastroenterol. 2014;20:5000–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Müller M, Canfora EE, Blaak EE. Gastrointestinal transit time, glucose homeostasis and metabolic health: modulation by dietary fibers. Nutrients. 2018;10:275.

    Article  PubMed Central  CAS  Google Scholar 

  36. Afshar S, Kelly SB, Seymour K, et al. The effects of bariatric procedures on bowel habit. Obes Surg. 2016;26:2348–54.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18:1287–96.

    Article  PubMed  Google Scholar 

  38. Titus R, Kastenmeier A, Otterson MF. Consequences of gastrointestinal surgery on drug absorption. Nutr Clin Pract. 2013;28:429–36.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  42. Saad RJ. The wireless motility capsule: a one-stop shop for the evaluation of GI motility disorders. Curr Gastroenterol Rep. 2016;18:14.

    Article  PubMed  Google Scholar 

  43. Wright RA, Krinsky S, Fleeman C, et al. Gastric emptying and obesity. Gastroenterology. 1983;84:747–51.

    Article  CAS  PubMed  Google Scholar 

  44. Al Mushref M, Srinivasan S. Effect of high fat-diet and obesity on gastrointestinal motility. Ann Transl Med. 2013;1:14.

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  47. Velchik MG, Reynolds JC, Alavi A. The effect of meal energy content on gastric emptying. J Nucl Med. 1989;30:1106–10.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The Talent Management Programme, Aalborg University, the Hørslev Foundation (No. 203866) and the Speciallæge Heinrich Kopps Foundation are acknowledged for supporting this study financially. Charlotte Skov at the Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, is acknowledged for her contribution in regards to patient recruitment. Torben Tvedebrink at the Statistical Department at Aalborg University is acknowledged for statistical support.

Author information

Authors and Affiliations

  1. Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Medicinerhuset 4th floor, Mølleparkvej 4, DK-9000, Aalborg, Denmark

    Louise Ladebo, Asbjørn M. Drewes & Christina Brock

  2. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Louise Ladebo, Pernille V. Pedersen, Asbjørn M. Drewes, Christina Brock & Anne E. Olesen

  3. Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    Grzegorz J. Pacyk & Jens Peter Kroustrup

  4. Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark

    Anne E. Olesen

Authors
  1. Louise Ladebo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pernille V. Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grzegorz J. Pacyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jens Peter Kroustrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Asbjørn M. Drewes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christina Brock
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne E. Olesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Louise Ladebo.

Ethics declarations

Ethics Declaration

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ladebo, L., Pedersen, P.V., Pacyk, G.J. et al. Gastrointestinal pH, Motility Patterns, and Transit Times After Roux-en-Y Gastric Bypass. OBES SURG 31, 2632–2640 (2021). https://doi.org/10.1007/s11695-021-05308-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-021-05308-x

Keywords

Search

Navigation