Intestinal Calcium Absorption in Patients after Jejuno-Ileal Bypass or Small Intestinal Resection and the Effect of Vitamin D

Nunan, T O; Compston, J.E.; Tonge, Christine M.

doi:10.1159/000199304

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…If biliopancreatic limb length is longer at our institution, and if the most proximal portion of the jejunum is crucial for calcium absorption, that might help explain the lower postoperative calcium absorption in our study. The dramatic decline we documented is reminiscent of the results of early studies of calcium absorption after jejunoileal bypass, an older bariatric operation [84,85]. It is clear, though, that maintaining robust vitamin D status and calcium intake after RYGB does not mitigate the fractional calcium absorption decline.…”

Section: Intestinal Calcium Transport After Bariatric Surgerymentioning

confidence: 66%

Vitamin D and intestinal calcium transport after bariatric surgery

Schafer

2017

The Journal of Steroid Biochemistry and Molecular Biology

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Bariatric surgery is a highly effective treatment for obesity, but it may have detrimental effects on the skeleton. Skeletal effects are multifactorial but mediated in part by nutrient malabsorption. While there is increasing interest in non-nutritional mechanisms such as changes in fat-derived and gut-derived hormones, nutritional factors are modifiable and thus represent potential opportunities to prevent and treat skeletal complications. This review begins with a discussion of normal intestinal calcium transport, including recent advances in our understanding of its regulation by vitamin D, and areas of continued uncertainty. Human and animal studies of vitamin D and intestinal calcium transport after bariatric surgery are then summarized. In humans, even with optimized 25-hydroxyvitamin D levels and recommended calcium intake, fractional calcium absorption decreased dramatically after Roux-en-Y gastric bypass (RYGB). In rats, intestinal calcium absorption was lower after RYGB than after sham surgery, despite elevated 1,25-dihyroxyvitamin D levels and intestinal gene expression evidence of vitamin D responsiveness. Such studies have the potential to shed new light on the physiology of vitamin D and intestinal calcium transport. Moreover, understanding the effects of bariatric surgery on these processes may improve the clinical care of bariatric surgery patients.

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Section: Intestinal Calcium Transport After Bariatric Surgerymentioning

confidence: 66%

Vitamin D and intestinal calcium transport after bariatric surgery

Schafer

2017

The Journal of Steroid Biochemistry and Molecular Biology

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“…Vitamin D supplementation should certainly be used in patients who have documented deficiency. Patients with significant small bowel resections are at significant risk for calcium malabsorption and often benefit from vitamin D supplementation (65,171). In patients with IBD who are not vitamin D deficient or hypocalcemic, vitamin D supplementation is not of proven benefit and one must be careful to avoid hypercalcemia.…”

Section: Calcium and Vitamin Dmentioning

confidence: 99%

“…Calcium absorption may increase up to 50% briefly (1 week) via these processes in younger patients (63,64j. Osteomalacia is a commonly associated clinical finding of calcium deficiency (or vitamin D). It may occur in patients with significant small bowel resections in the absence of vitamin D supplementation, and may be present without associated clinical (such as bone pain, muscle weakness), radiologic (such as osteopenia with Looser's zones [bending and enlarged epiphyses in children] of the long bones), or biochemical abnormalities (such as increased serum alkaline phosphatase concentration, hypocalcemia, or hypovitaminosis D) (65)(66)(67). Bone biopsy may be necessary for diagnosis, and patients may have a mixed picture of osteomalacia and osteoporosis (65,67).…”

Section: Calcium Malabsorptionmentioning

confidence: 99%

Bones and Crohn's: Problems and solutions

Buchman

2007

Inflamm Bowel Dis

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Inflammatory bowel disease may manifest in various extra intestinal manifestations. Osteopenia and various arthropathies may be debilitating. These may be related to the disease itself, patient genetics, lifestyle, or disease treatment. Calcium and vitamin D malabsorption, vitamin K deficiency, malnutrition, corticosteroid and other immunosuppressive medications, smoking, lack of exercise and postmenopausal state may all play important roles. Treatment may be undertaken to correct nutrient deficiencies, inhibit bone resorption and increase bone formation.

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“…Roux‐en‐Y gastric bypass (RYGB) 1 surgery is considered to be the gold standard alternative treatment for severe obesity because it should result in less severe malabsorption and complications than traditional malabsorptive procedures (i.e., jejuno‐ileal bypass) (1, 2, 3). The malabsorptive procedures have been recognized as a risk factor for developing bone disease (4, 5, 6, 7, 8, 9) as a result of altered calcium (Ca) metabolism and compromised Ca absorption (10, 11, 12, 13, 14, 15, 16). Only a few studies have investigated Ca absorption prospectively in jejuno‐ileal bypass patients and have shown that Ca absorption decreases by ∼50% after surgery (10, 13, 16).…”

Section: Introductionmentioning

confidence: 99%

True Fractional Calcium Absorption is Decreased After Roux‐En‐Y Gastric Bypass Surgery

Riedt

Brolin

Sherrell

et al. 2006

Obesity

150

102

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RIEDT, CLAUDIA S., ROBERT E. BROLIN, ROBERT M. SHERRELL, M. PAUL FIELD, AND SUE A. SHAPSES. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity. 2006;14: 1940 -1948. Objective: Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard alternative treatment for severe obesity. Weight loss after RYGB results primarily from decreased food intake. Inadequate calcium (Ca) intake and metabolic bone disease can occur after gastric bypass. To our knowledge, whether malabsorption of Ca contributes to an altered Ca metabolism in the RYGB patient has not been addressed previously. Research Methods and Procedures:We recruited 25 extremely obese women in order to study true fractional Ca absorption (TFCA) before and 6 months after RYGB surgery, using a dual stable isotope method ( 42 Ca and 43 Ca) and test load of Ca (200 mg). Hormones regulating Ca absorption and markers of bone turnover were also measured. Results: In 21 women (BMI 52.7 Ϯ 8.3 kg/m 2 , age 43.9 Ϯ 10.4 years) who successfully completed the study, TFCA decreased from 0.36 Ϯ 0.08 to 0.24 Ϯ 0.09 (p Ͻ 0.001) after RYGB. Bone turnover markers increased significantly (p Ͻ 0.01). TFCA correlated with estradiol levels (r ϭ 0.512, p Ͻ 0.02) and tended to correlate with 1,25 (OH) 2 D (r ϭ 0.427, p Ͻ 0.06) at final measurement. Stepwise linear regression indicated that estradiol explained 62% of the variance for TFCA at 6 months post-surgery (p Ͻ 0.01). Discussion: TFCA decreases (0.12 Ϯ 0.08) after RYGB surgery but remains within normal range. Although only some patients were estimated to have low Ca absorption after surgery, all of the patients showed a dramatic increase in markers of bone resorption. The alteration in Ca metabolism after RYGB-induced weight loss appears to be regulated primarily by estradiol levels and might ultimately affect bone mass.

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Intestinal Calcium Absorption in Patients after Jejuno-Ileal Bypass or Small Intestinal Resection and the Effect of Vitamin D

Cited by 13 publications

References 21 publications

Vitamin D and intestinal calcium transport after bariatric surgery

Vitamin D and intestinal calcium transport after bariatric surgery

Bones and Crohn's: Problems and solutions

True Fractional Calcium Absorption is Decreased After Roux‐En‐Y Gastric Bypass Surgery

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