Oral Vitamin B12 Supplementation After Roux-en-Y Gastric Bypass: a Systematic Review

Mahawar, Kamal; Reid, Alastair; Graham, Yitka; Callejas‐Diaz, Lindes; Parmar, Chetan; Carr, William; Jennings, Neil; Singhal, Rishi; Small, Peter

doi:10.1007/s11695-017-3102-y

Cited by 20 publications

(12 citation statements)

References 30 publications

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“…Vitamin B12 absorption is adversely affected by SG, RYGB and BPD/DS as it requires an acidic environment and presence of intrinsic factor produced by the gastric parietal cells 95 . Many people have about 2‐year stores of vitamin B12; therefore, deficiency may present several years after surgery 15,18,19,40,41,47,57–59,65,73,86–89,92,93,96 . Vitamin B12 deficiency impacts adversely on the haematopoietic and nervous systems and may result in megaloblastic anaemia and irreversible neuropathies 95 .…”

Section: Postoperative Care and Biochemical Monitoringmentioning

confidence: 99%

“…Further research is needed, as deficiency may still occur in the presence of high oral doses 34,92,136 . Adherence to oral supplementation is more difficult to determine 34,96,133–135 . Given the serious consequences of vitamin B12 deficiency, we recommend routine supplementation with three monthly intramuscular vitamin B12 injections for SG, RYGB and malabsorptive procedures such as BPD/DS 134 …”

Section: Vitamin and Mineral Supplementationmentioning

confidence: 99%

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British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

et al. 2020

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Bariatric surgery is recognized as the most clinically and cost-effective treatment for people with severe and complex obesity. Many people presenting for surgery have pre-existing low vitamin and mineral concentrations. The incidence of these may increase after bariatric surgery as all procedures potentially cause clinically significant micronutrient deficiencies. Therefore, preparation for surgery and long-term nutritional monitoring and follow-up are essential components of bariatric surgical care. These guidelines update the 2014 British Obesity and Metabolic Surgery Society nutritional guidelines. Since the 2014 guidelines, the working group has been expanded to include healthcare professionals working in specialist and non-specialist care as well as patient representatives. In addition, in these updated guidelines, the current evidence has been systematically reviewed for adults and adolescents undergoing the following procedures: adjustable gastric band, sleeve gastrectomy, Rouxen-Y gastric bypass and biliopancreatic diversion/duodenal switch. Using methods based on Scottish Intercollegiate Guidelines Network methodology, the levels of evidence and recommendations have been graded. These guidelines are comprehensive,

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Section: Postoperative Care and Biochemical Monitoringmentioning

confidence: 99%

Section: Vitamin and Mineral Supplementationmentioning

confidence: 99%

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

et al. 2020

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“…The multivitamin used in the study by Homan et al included 350 μg of vitamin B 12 [48], which may be sufficient to overcome deficiency as 1-5% of vitamin B 12 is absorbed by an intrinsic factor-independent mechanism [16]. However, other studies demonstrated higher doses of oral hydroxocobalamin are required, with 1000 μg per day proving optimal to manage vitamin B 12 deficiency after GB [50]. Furthermore, in a study comparing oral and intramuscular cobalamin, there was no significant difference in improvement in vitamin B 12 levels, suggesting that high-dose oral vitamin B 12 (1000 μg per day) is sufficient to overcome deficiency [51].…”

Section: Discussionmentioning

confidence: 99%

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

et al. 2020

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Purpose Bariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B 12 , folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up. Materials and Methods We performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England. Results At baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m 2 , serum vitamin B 12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B 12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period. Conclusion There were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B 12 , folic acid, and iron in people undergoing bariatric surgery.

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“…Appropriate dosages for various micronutrient supplementations after RYGB are now becoming clearer [47][48][49][50][51] but there is as yet no clarity on these doses for patients undergoing OAGB even though there is consensus [3] that these patients need lifelong supplementation with iron, vitamin D and Calcium, Vitamin B12, and a multivitamin containing appropriate amounts of Zinc and Copper.…”

Section: Prevention and Management Of Micronutrient Deficiencymentioning

confidence: 99%

“…We hypothesise that OAGB patients should be advised lifelong supplementation with a) two multivitamin/mineral tablet, each containing at least 1.0 gram of Copper and 15 mg of Zinc b) parenteral supplementation with 1 mg vitamin B12 every 3 months or oral supplementation with 1.5 mg vitamin B12 daily c) Iron supplementation with at least 120 mg elemental iron daily d) Calcium supplementation with 1500 mg elemental calcium, and e) vitamin D 3000 international units daily. These doses are based on our experience with OAGB [46] and the literature on RYGB extrapolated to higher requirements with OAGB [47][48][49][50][51]. We believe these dosages can serve as useful starting points for the supplementation of various micronutrients after OAGB until further data emerges.…”

Section: Prevention and Management Of Micronutrient Deficiencymentioning

confidence: 99%

One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications

Mahawar¹,

Parmar²,

Graham³

2019

Minerva Chir

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Introduction: One Anastomosis Gastric Bypass (OAGB) is now a recognised mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications. Evidence Acquisition:We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names.Evidence Synthesis: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch, and maintains a safe distance from the angle of His. A Bilio-Pancreatic limb length of 150 cm appears to be safest and a limb length of > 200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen's space to prevent Petersen's hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and Gastro-Oesophageal Reflux Disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg Copper and 15 mg Zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental Calcium daily, and 3000 international units of vitamin D daily. Conclusion:This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.

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Oral Vitamin B12 Supplementation After Roux-en-Y Gastric Bypass: a Systematic Review

Cited by 20 publications

References 30 publications

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications

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