Obesity Surgery

, Volume 24, Issue 5, pp 796–805 | Cite as

The Effect of Bariatric Surgery on Intestinal Absorption and Transit Time

  • Kirstin A. Carswell
  • Royce P. Vincent
  • Ajay P. Belgaumkar
  • Roy A. Sherwood
  • Stephanie A. Amiel
  • Ameet G. Patel
  • Carel W. le Roux
Original Contributions

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.

Keywords

Bariatrics Bariatric surgery Gastric bypass Biliopancreatic diversion Intestinal absorption 

Abbreviations

AGB

Adjustable gastric band

BPD

Biliopancreatic diversion

BMI

Body mass index

DS

Biliopancreatic diversion with duodenal switch

ELISA

Enzyme linked immunosorbent assay

FCp

Faecal calprotectin

FE-1

Faecal elastase-1

GLP-1

Glucagon-like peptide 1

GLP-2

Glucagon-like peptide 2

HPLC

High-performance liquid chromatography

PYY

Peptide tyrosine-tyrosine

RYGB

Roux-en-Y gastric bypass

SBPT

Small bowel permeability test

SP

Sulphapyridine

SZ

Sulphasalazine

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kirstin A. Carswell
    • 1
  • Royce P. Vincent
    • 2
  • Ajay P. Belgaumkar
    • 1
  • Roy A. Sherwood
    • 2
  • Stephanie A. Amiel
    • 3
  • Ameet G. Patel
    • 1
  • Carel W. le Roux
    • 2
    • 4
  1. 1.Department of General SurgeryKing’s College HospitalLondonUK
  2. 2.Department of Clinical BiochemistryKing’s College HospitalLondonUK
  3. 3.Division of Diabetes and Nutritional SciencesKing’s College LondonLondonUK
  4. 4.Experimental Pathology, Conway Institute, School of Medicine and Medical ScienceUniversity College DublinDublinIreland

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