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Gastric Emptying and Postprandial PYY Response After Biliopancreatic Diversion with Duodenal Switch

  • Physiology Research
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Abstract

Background

Super-obesity (BMI > 50) is increasing rapidly. We use the biliopancreatic diversion with duodenal switch (BPD-DS) as one option in this patient category. The aim of the present study was to investigate the emptying of the gastric tube, PYY levels and dumping symptoms after BPD-DS.

Methods

Emptying of the gastric tube was investigated with scintigraphy after an overnight fast. Twenty patients (median age 43 years, BMI 31.1 kg/m2) having undergone BPD-DS in median 3.5 years previously were included in the scintigraphic study. A technetium-labelled omelette was ingested and scintigraphic evaluation of gastric emptying was undertaken. Ten of the patients also underwent PYY measurements after a standardised meal and were compared to nine non-operated age-matched normal weight controls, both in the fasting state and after the test meal. Frequency of dumping symptoms was evaluated in all patients.

Results

The half-emptying time was 28 ± 16 min. Lag phase was present in 30% of the patients. PYY levels were significantly higher in BPD-DS patients as compared to controls both in the fasting state (p < 0.001) and after the test meal (p < 0.001). Dumping symptoms were scarce and occurred in 17 of the 20 patients only few times yearly or less.

Conclusions

Although the pylorus is preserved in BPD-DS, the stomach emptying is faster than in non-operated subjects. PYY levels are elevated in the fasting state after BPD-DS and a marked response to a test meal is seen, likely due to the rapid stimulation of intraluminal nutrients in the distal ileum. In spite of this, dumping symptoms are uncommon.

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden

    Jakob Hedberg & Magnus Sundbom

  2. Institute of Medical Sciences, Uppsala University, Uppsala, Sweden

    F. Anders Karlsson & Britt Edén-Engström

  3. Department of Clinical Physiology, Uppsala University, Uppsala, Sweden

    Hans Hedenström

Authors
  1. Jakob Hedberg
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  2. Hans Hedenström
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  3. F. Anders Karlsson
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  4. Britt Edén-Engström
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  5. Magnus Sundbom
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Correspondence to Jakob Hedberg.

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Hedberg, J., Hedenström, H., Karlsson, F.A. et al. Gastric Emptying and Postprandial PYY Response After Biliopancreatic Diversion with Duodenal Switch. OBES SURG 21, 609–615 (2011). https://doi.org/10.1007/s11695-010-0288-7

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