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Effects of Probiotic Use on Gastrointestinal Symptoms in the Late Postoperative Period of Bariatric Surgery: A Cross-Over, Randomized, Triple-Blind, Placebo-Controlled Study

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Abstract

Introduction

Despite the benefits associated with weight reduction, the anatomical and functional changes of bariatric surgery may favor the development of undesirable side effects such as the appearance of gastrointestinal symptoms (GIS). The aim of this study was to evaluate the effects of using probiotics in individuals with GIS 1 year after being submitted to Roux-en-Y Gastric Bypass (RYGB).

Materials and Methods

This is an experimental, prospective, randomized, cross-over, triple-blind, placebo-controlled study, carried out with patients 1 year after being submitted to RYGB and who reported at least one moderate GIS. Subjects were randomized into two groups and completed the two research periods: in one they received placebo capsules, in the other 50 billion CFU of probiotics (Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus rhamnosus, Bifidobacterium longum, Lactobacillus plantarum, Bifidobacterium bifidum and Lactobacillus gasseri), both for 8 weeks, with 8 weeks of wash-out period in between, and were evaluated for the presence of Small Intestine Bacterial Overgrowth (SIBO) and GIS, through the Hydrogen breath test and Gastric Symptom Rating Scale (GSRS) questionnaire.

Results

Of a total of 56 participants, 47 individuals completed the study. No significant effects were observed in neither the gastrointestinal symptoms or in the prevalence of SIBO with the use of probiotics.

Conclusion

Supplementation of the probiotics chosen for this study does not seem to alleviate GIS or influence the improvement of SIBO in symptomatic patients after 1 year of RYGB.

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References

  1. Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14(4):435. https://doi.org/10.3390/ijerph14040435.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (sbcbm). Tratamento Cirúrgico: Técnicas Cirúrgicas, 2017. Portuguese. Available from: www.sbcbm.org.br/tecnicas-cirurgicas-bariatrica/

  3. Brown W, Shikora S, Liem R, Holland J, Campbell AB, Sprinkhuizen SM, et al. 7th IFSO global registry report. International federation for the surgery of obesity and metabolic disorders. 2022. Available from: https://www.ifso.com/pdf/ifso-7th-registry-report-2022.pdf.

  4. Høgestøl IK, Chahal-Kummen M, Eribe I, Brunborg C, Stubhaug A, Hewitt S, et al. Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid obesity. Obes Surg. 2017;27(6):1438–45. https://doi.org/10.1007/s11695-016-2499-z.

    Article  PubMed  Google Scholar 

  5. Boerlage TCC, Westerink F, van de Laar AWJM, Hutten BA, Brandjes DPM, Gerdes VEA. Gastrointestinal symptoms before and after laparoscopic Roux-en-Y gastric bypass: a longitudinal assessment. Surg Obes Relat Dis. 2019;15(6):871–7. https://doi.org/10.1016/j.soard.2019.03.018.

    Article  PubMed  Google Scholar 

  6. Gentile JKA, Oliveira KD, Pereira JG, Tanaka DY, Guidini GN, Cadona MZ, et al. The intestinal microbiome in patients undergoing bariatric surgery: a systematic review. Arq Bras Cir Dig. 2022;19(35): e1707. https://doi.org/10.1590/0102-672020220002e1707.

    Article  Google Scholar 

  7. Woodard GA, Encarnacion B, Downey JR, Peraza J, Chong K, Hernandez-Boussard T, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204. https://doi.org/10.1007/s11605-009-0891-x.

    Article  PubMed  Google Scholar 

  8. Chen JC, Lee WJ, Tsou JJ, Liu TP, Tsai PL. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(1):57–61. https://doi.org/10.1016/j.soard.2015.07.010.

    Article  PubMed  Google Scholar 

  9. Wagner NRF, Ramos MRZ, de Oliveira CL, da Cruz MRR, Taconeli CA, Filho AJB, et al. Effects of probiotics supplementation on gastrointestinal symptoms and SIBO after roux-en-Y gastric bypass: a prospective, randomized, double-blind. Placebo-Controlled Trial Obes Surg. 2021;31(1):143–50. https://doi.org/10.1007/s11695-020-04900-x.

    Article  PubMed  Google Scholar 

  10. Lynch E, Troob J, Lebwohl B, Freedberg DE. Who uses probiotics and why? A survey study conducted among general gastroenterology patients. BMJ Open Gastroenterol. 2021;8(1):e000742. https://doi.org/10.1136/bmjgast-2021-000742.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Harris LA, Cash BD, Moftah K, Franklin H. An open-label, multicenter study to assess the efficacy and safety of a novel probiotic blend in patients with functional gastrointestinal symptoms. J Clin Gastroenterol. 2022;56(5):444–451. https://doi.org/10.1097/MCG.0000000000001567.

  12. Han ML, Lee MH, Lee WJ, Chen SC, Almalki OM, Chen JC, et al. Probiotics for gallstone prevention in patients with bariatric surgery: a prospective randomized trial. Asian J Surg. 2022;45(12):2664–9. https://doi.org/10.1016/j.asjsur.2022.01.120.

    Article  PubMed  Google Scholar 

  13. Nowicki KN, Pories WJ. Bacteria with potential: improving outcomes through probiotic use following Roux-en-Y gastric bypass. Clin Obes. 2023;13(1):e12552. https://doi.org/10.1111/cob.12552.

    Article  PubMed  Google Scholar 

  14. Swierz MJ, Storman D, Staskiewicz W, et al. Efficacy of probiotics in patients with morbid obesity undergoing bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2020;16(12):2105–16. https://doi.org/10.1016/j.soard.2020.08.038.

    Article  PubMed  Google Scholar 

  15. Gutiérrez-Repiso C, Moreno-Indias I, Tinahones FJ. Shifts in gut microbiota and their metabolites induced by bariatric surgery. Impact of factors shaping gut microbiota on bariatric surgery outcomes. Rev Endocr Metab Disord. 2021;22(4):1137–1156. https://doi.org/10.1007/s11154-021-09676-8.

  16. Waitzberg DL, Quilici FA, Michzputen S, Friche Passos M. do C. The effect of probiotic fermented milk that includes Bifidobacterium lactis cncm i-2494 on the reduction of gastrointestinal discomfort and symptoms in adults: a narrative review. Nutr Hosp. 2015;32(2):501–9. https://doi.org/10.3305/nh.2015.32.2.9232.

  17. Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020;39(10):2960–9. https://doi.org/10.1016/j.clnu.2020.01.005.

    Article  PubMed  Google Scholar 

  18. Botelho PB, Ferreira MVR, Araújo AM, Mendes MM, Nakano EY. Effect of multispecies probiotic on gut microbiota composition in individuals with intestinal constipation: a double-blind, placebo-controlled randomized trial. Nutrition. 2020;78:110890. https://doi.org/10.1016/j.nut.2020.110890.

    Article  CAS  PubMed  Google Scholar 

  19. Souza GS, Sardá FA, Giuntini EB, Gumbrevicius I, Morais MB, Menezes EW. Translation and validation of the brazilian portuguese version of the gastrointestinal symptom rating scale (GSRS) questionnaire. Arq Gastroenterol. 2016;53(3):146–51. https://doi.org/10.1590/S0004-28032016000300005.

  20. Moizé VL, Pi-Sunyer X, Mochari H, Vidal J. Nutritional pyramid for post-gastric bypass patients. Obes Surg. 2010;20(8):1133–41. https://doi.org/10.1007/s11695-010-0160-9.

    Article  PubMed  Google Scholar 

  21. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62. https://doi.org/10.1136/bjsports-2020-102955.

    Article  PubMed  Google Scholar 

  22. Stefanidis D, Navarro F, Augenstein VA, Gersin KS, Heniford BT. Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc. 2012;26(12):3521–7. https://doi.org/10.1007/s00464-012-2380-7.

    Article  PubMed  Google Scholar 

  23. Yormaz S, Yilmaz K, Alptekin H, Ece I, Acar F, Colak B, et al. Does digestive symptoms require esophago gastroscopy prior to bariatric procedure? Assessment of 6 years’ experience. Ann Ital Chir. 2018;89:36–44.

    PubMed  Google Scholar 

  24. Manterola D Carlos, Urrutia V Sebastián, Otzen H Tamara. Calidad de vida relacionada con salud: Instrumentos de medición para valoración de resultados en cirugía digestiva alta. Rev Chil Cir [Internet]. 2014 [citado 2023 Ago 08]; 66(3):274–282. https://doi.org/10.4067/S0718-40262014000300016.

  25. Andalib I, Shah H, Bal BS, Shope TR, Finelli FC, Koch TR. Breath hydrogen as a biomarker for glucose malabsorption after Roux-en-Y gastric bypass surgery. Dis Mark. 2015;2015:102760. https://doi.org/10.1155/2015/102760.

  26. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol. 2020;115(2):165–78. https://doi.org/10.14309/ajg.0000000000000501.

    Article  PubMed  Google Scholar 

  27. Waller PA, Gopal PK, Leyer GJ, Ouwehand AC, Reifer C, Stewart ME, et al. Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults. Scand J Gastroenterol. 2011;46(9):1057–64. https://doi.org/10.3109/00365521.2011.584895.

  28. Gomi A, Yamaji K, Watanabe O, Yoshioka M, Miyazaki K, Iwama Y, et al. Bifidobacterium bifidum YIT 10347 fermented milk exerts beneficial effects on gastrointestinal discomfort and symptoms in healthy adults: a double-blind, randomized, placebo-controlled study. J Dairy Sci. 2018;101(6):4830–41. https://doi.org/10.3168/jds.2017-13803.

    Article  CAS  PubMed  Google Scholar 

  29. Francavilla R, Piccolo M, Francavilla A, Polimeno L, Semeraro F, Cristofori F, et al. Clinical and microbiological effect of a multispecies probiotic supplementation in celiac patients with persistent IBS-type symptoms: a randomized, double-blind, placebo-controlled. Multicenter Trial J Clin Gastroenterol. 2019;53(3):e117–25. https://doi.org/10.1097/MCG.0000000000001023.

    Article  CAS  PubMed  Google Scholar 

  30. Martoni CJ, Srivastava S, Leyer GJ. Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 improve abdominal pain severity and symptomology in irritable bowel syndrome: randomized controlled trial. Nutrients. 2020;12(2):363. https://doi.org/10.3390/nu12020363.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hata S, Nakajima H, Hashimoto Y, Miyoshi T, Hosomi Y, Okamura T, et al. Effects of probiotic Bifidobacterium bifidum G9–1 on the gastrointestinal symptoms of patients with type 2 diabetes mellitus treated with metformin: An open-label, single-arm, exploratory research trial. J Diabetes Investig. 2022;13(3):489–500. https://doi.org/10.1111/jdi.13698.

  32. Pereira SE, Rossoni C, Cambi MPC, Faria SL, Mattos FCC, De Campos TBF, et al. Brazilian guide to nutrition in bariatric and metabolic surgery. Langenbecks Arch Surg. 2023;408(1):143. https://doi.org/10.1007/s00423-023-02868-7.

    Article  PubMed  Google Scholar 

  33. Peters V, Dijkstra G, Campmans-Kuijpers MJE. Are all dietary fibers equal for patients with inflammatory bowel disease? A systematic review of randomized controlled trials. Nutr Rev. 2022;80(5):1179–93. https://doi.org/10.1093/nutrit/nuab062.

    Article  PubMed  Google Scholar 

  34. Wijdeveld M, van Olst N, van der Vossen EWJ, de Brauw M, Acherman YIZ, de Goffau MC, et al. Identifying Gut Microbiota associated with Gastrointestinal Symptoms upon Roux-en-Y Gastric Bypass. Obes Surg. 2023;33(6):1635–1645. https://doi.org/10.1007/s11695-023-06610-6.

  35. Mouillot T, Rhyman N, Gauthier C, Paris J, Lang AS, Lepers-Tassy S, et al. Study of small intestinal bacterial overgrowth in a cohort of patients with abdominal symptoms who underwent bariatric surgery. Obes Surg. 2020;30(6):2331–7. https://doi.org/10.1007/s11695-020-04477-5.

    Article  PubMed  Google Scholar 

  36. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, et al. 1st Rome H2-Breath Testing Consensus Conference Working Group. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009;29 Suppl 1:1–49. https://doi.org/10.1111/j.1365-2036.2009.03951.x. Erratum in: Aliment Pharmacol Ther. 2010 Jan;31(1):166. Satta PU [corrected to Usai-Satta P].

  37. Bauserman M, Michail S. The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial. J Pediatr. 2005;147(2):197-201. https://doi.org/10.1016/j.jpeds.2005.05.015. Erratum in: J Pediatr. 2014 Oct;165(4):878. Bausserman, Melissa [corrected to Bauserman, Melissa].

  38. Ciobârcă D, Cătoi AF, Copăescu C, Miere D, Crișan G. Bariatric surgery in obesity: effects on gut microbiota and micronutrient status. Nutrients. 2020;12(1):235. https://doi.org/10.3390/nu12010235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Alhusain F. Microbiome: role and functionality in human nutrition cycle. Saudi Med J. 2021;42(2):146–50. https://doi.org/10.15537/smj.2021.2.25587.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Universidade Federal Do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, 80060-900, Brazil

    Nathalia Ramori Farinha Wagner, Maria Clara Peixoto Lopes & Antonio Carlos Ligocki Campos

  2. Universidade Federal da Grande Dourados (UFGD), Rodovia Dourados/Itahum, Km 12, Cidade Universitária, Dourados, MS, 79804-970, Brazil

    Ricardo Fernandes

  3. Universidade Federal Do Paraná (UFPR), R. Evaristo F. Ferreira da Costa, 408, Jardim Ds Americas, Curitiba, 81530-090, Brazil

    Cesar Augusto Taconelli

  4. Universidade Federal de Santa Catarina (UFSC), Campus Universitário Reitor João David Ferreira Lima, S/nº, Trindade, Florianópolis, SC, 88040-900, Brazil

    Giovanna Mozzaquatro Nascimento, Julia Pessini & Erasmo Benicio Santos de Moraes Trindade

  5. Curitiba, Brazil

    Nathalia Ramori Farinha Wagner

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Correspondence to Nathalia Ramori Farinha Wagner.

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Conflicts of Interest

The authors declare they have no conflicts of interest. The probiotics and placebo were donated by Pure Encapsulations (Nestlé Health Science, Hoboken, NJ, USA). The authors report non-financial support from Pure Encapsulations. Pure Encapsulations had no influence on writing or interpreting the data.

Nathalia Ramori Farinha Wagner—no conflict of interest.

Maria Clara Peixoto Lopes—no conflict of interest.

Ricardo Fernandes—no conflict of interest.

Cesar Augusto Taconelli—no conflict of interest.

Giovanna Mozzaquatro Nascimento—no conflict of interest.

Julia Pessini—no conflict of interest.

Erasmo Benicio Santos de Moraes Trindade—no conflict of interest.

Antonio Carlos L. Campos—no conflict of interest.

Ethical Approval

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.

Informed Consent

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

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Key points.

1. A total of 69% of the individuals with 1 year of RYGB reported the presence of at least one moderate GIS.

2. The use of probiotics does not seem to alleviate GIS in individuals after 1 year of RYGB.

3. The use of probiotics after RYGB did not reduce SIBO in this study.

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Wagner, N.R.F., Lopes, M.C.P., Fernandes, R. et al. Effects of Probiotic Use on Gastrointestinal Symptoms in the Late Postoperative Period of Bariatric Surgery: A Cross-Over, Randomized, Triple-Blind, Placebo-Controlled Study. OBES SURG 34, 1306–1315 (2024). https://doi.org/10.1007/s11695-024-07117-4

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