Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes

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Härma , M-A , Adeshara , K , Istomin , N , Lehto , M , Blaut , M , Savolainen , M J , Hörkkö , S , Groop , P-H , Koivukangas , V & Hukkanen , J 2021 , ' Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes ' , Surgery for Obesity and Related Diseases , vol. 17 , no. 3 , pp. 585-594 . https://doi.org/10.1016/j.soard.2020.10.021

Title: Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes
Author: Härma, Mari-Anne; Adeshara, Krishna; Istomin, Natalie; Lehto, Markku; Blaut, Michael; Savolainen, Markku J.; Hörkkö, Sohvi; Groop, Per-Henrik; Koivukangas, Vesa; Hukkanen, Janne
Contributor organization: HUS Abdominal Center
Nefrologian yksikkö
Department of Medicine
Per Henrik Groop / Principal Investigator
Clinicum
Date: 2021-03
Language: eng
Number of pages: 10
Belongs to series: Surgery for Obesity and Related Diseases
ISSN: 1550-7289
DOI: https://doi.org/10.1016/j.soard.2020.10.021
URI: http://hdl.handle.net/10138/341356
Abstract: Background: Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity, which improves cardiovascular health and reduces the risk of premature mortality. However, some reports have suggested that RYGB may predispose patients to adverse health outcomes, such as inflammatory bowel disease (IBD) and colorectal cancer. Objectives: The present prospective study aimed to evaluate the impact of RYGB surgery on cardiovascular risk factors and gastrointestinal inflammation in individuals with and without type 2 diabetes (T2D). Setting: University hospital setting in Finland. Methods: Blood and fecal samples were collected at baseline and 6 months after surgery from 30 individuals, of which 16 had T2D and 14 were nondiabetics. There were also single study visits for 6 healthy reference patients. Changes in cardiovascular risk factors, serum cholesterol, and triglycerides were investigated before and after surgery. Fecal samples were analyzed for calprotectin, anti-Saccharomyces cerevisiae immunoglobulin A antibodies (ASCA), active lipopolysaccharide (LPS) concentration, short-chain fatty acids (SCFAs), intestinal alkaline phosphatase activity, and methylglyoxal-hydro-imidazolone (MG-H1) protein adducts formation. Results: After RYGB, weight decreased on average 221.6% (-27.2 +/- 7.8 kg), excess weight loss averaged 51%, and there were improvements in cardiovascular risk factors. Fecal calprotectin levels (P < .001), active LPS concentration (P < .002), ASCA (P < .02), and MG-H1 (P < .02) values increased significantly, whereas fecal SCFAs, especially acetate (P < .002) and butyrate (P < .03) levels, were significantly lowered. Conclusion: The intestinal homeostasis is altered after RYGB, with several fecal markers suggesting increased inflammation; however, clinical significance of the detected changes is currently uncertain. As chronic inflammation may predispose patients to adverse health effects, our findings may have relevance for the suggested association between RYGB and increased risks of incident IBD and colorectal cancer. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Subject: Calprotectin
Intestinal inflammation
Roux-en-Y gastric bypass surgery
Short-chain fatty acids
Type 2 diabetes
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: acceptedVersion


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