Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass

Steenackers, Nele; Vanuytsel, Tim; Augustijns, Patrick; Tack, Jan; Mertens, Ann; Lannoo, Matthias; Schueren, Bart Van der; Matthys, Christophe

doi:10.1016/s2468-1253(20)30302-2

Cited by 70 publications

(44 citation statements)

References 154 publications

(229 reference statements)

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“…In addition, a large area for absorption with region-specific transporters is bypassed resulting in a short absorption surface of the common limb. Together, these gastrointestinal physiological alterations can contribute to micronutrient malabsorption [ 26 ]. Moreover, an excessive reduction i caloric intake, food intolerance, non-compliance to nutritional supplementation or short-intestinal bacterial overgrowth can contribute or even aggravate the nutritional status after surgery [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Late complications of biliopancreatic diversion in an older patient: a case report

et al. 2021

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Background In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications. Case presentation A 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning. Conclusions Long-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.

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Section: Discussionmentioning

confidence: 99%

Late complications of biliopancreatic diversion in an older patient: a case report

et al. 2021

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“…The transit time and stomach volume were decreased since RYGB surgery involves the creation of a smaller gastric pouch. Following the operation, acid secretion from the stomach is decreased [42], resulting in higher gastric pH [43]. Therefore, the pH was increased (Table 2).…”

Section: Development Of a Post-rygb Physiology Modelmentioning

confidence: 99%

Optimized In Silico Modeling of Drug Absorption after Gastric Bypass: The Case of Metformin

et al. 2021

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Bariatric surgery is an effective treatment for severe obesity and related comorbidities, such as type II diabetes. Gastric bypass surgery shortens the length of the intestine, possibly leading to altered drug absorption. Metformin, a first-line treatment for type II diabetes, has permeability-dependent drug absorption, which may be sensitive to intestinal anatomic changes during bypass surgery, including Roux-en-Y gastric bypass (RYGB). Previous computer simulation data indicate increased metformin absorption after RYGB. In this study, we experimentally determined the region-dependent permeability of metformin, using the rat single-pass intestinal perfusion method (SPIP), which we then implemented into GastroPlusTM to assess the contribution of our SPIP data to post-RYGB metformin absorption modeling. Previous simulations allowed a good fit with in vivo literature data on healthy and obese control subjects. However, it was revealed that for post-RYGB drug absorption predictions, simply excluding the duodenum/jejunum is insufficient, as the software underestimates the observed plasma concentrations post-RYGB. By implementing experimentally determined segmental-dependent permeabilities for metformin in the remaining segments post-surgery, GastroPlusTM proved to fit the observed plasma concentration profile, making it a useful tool for predicting drug absorption after gastric bypass. Reliable evaluation of the parameters dictating drug absorption is required for the accurate prediction of overall absorption after bariatric surgery.

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“…On the other hand, if drug levels are found to be high and/or the patient cannot tolerate the lamotrigine treatment, dose may have to eventually be gradually decreased. To note, some of these undesirable situations may be temporary, as adaptation mechanisms may occur in the months following the surgery, and changes in weight also take place [ 41 ].…”

Section: Clinical Recommendationsmentioning

confidence: 99%

Managing the Unpredictable: Mechanistic Analysis and Clinical Recommendations for Lamotrigine Treatment after Bariatric Surgery

Porat

Azran

Kadı

et al. 2021

JCM

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Bariatric surgery may alter the absorption and overall bioavailability of oral drugs. Lamotrigine is a major antiepileptic and mood stabilizer, that its use after bariatric surgery has not yet been studied. In this article, we provide a thorough mechanistic analysis of the effects of bariatric surgery on multiple mechanisms important for the absorption, bioavailability and overall pharmacokinetics of lamotrigine. Attributable to its pharmacokinetic properties and drug characteristics, the use of lamotrigine after bariatric surgery may be challenging. The complex situation in which some mechanisms may lead to increased drug exposure (e.g., decreased metabolism, weight loss) while others to its decrease (e.g., hampered dissolution/solubility, decreased gastric volume), may result in lowered, unchanged, or enhanced lamotrigine plasma levels after the surgery. We conclude with a set of clinical recommendations for lamotrigine treatment after bariatric surgery, aiming to allow better patient care, and emphasizing the extra caution that needs to be taken with these patients.

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Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass

Cited by 70 publications

References 154 publications

Late complications of biliopancreatic diversion in an older patient: a case report

Late complications of biliopancreatic diversion in an older patient: a case report

Optimized In Silico Modeling of Drug Absorption after Gastric Bypass: The Case of Metformin

Managing the Unpredictable: Mechanistic Analysis and Clinical Recommendations for Lamotrigine Treatment after Bariatric Surgery

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