Gastrointestinal pH, Motility Patterns, and Transit Times After Roux-en-Y Gastric Bypass.
Gastric bypass
Gastrointestinal pH
Gastrointestinal transit
Motility
Pharmacotherapeutics
Smartpill
Wireless motility capsule
Journal
Obesity surgery
ISSN: 1708-0428
Titre abrégé: Obes Surg
Pays: United States
ID NLM: 9106714
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
21
12
2020
accepted:
23
02
2021
revised:
17
02
2021
pubmed:
13
3
2021
medline:
21
5
2021
entrez:
12
3
2021
Statut:
ppublish
Résumé
Studies investigating the underlying pathophysiology are needed to help explain and understand the postoperative complications following Roux-en-Y gastric bypass (RYGB) surgery. This study aimed to characterize segmental gastrointestinal pH profiles, motility measures, and transit times in patients with RYGB. Nineteen patients with RYGB underwent a standardized wireless motility capsule assessment. The oro-cecal segment was defined from capsule ingestion until the passage of the ileocecal junction. Segmental median pH, motility index, and transit time were determined for the oro-cecal and colonic segment as well as for the first and last hour of both these segments. For comparison to reference values, data from 17 healthy age- and gender-matched controls was used. A mixed effect model was used to describe differences between groups. Median pH was high in patients with RYGB during the first hour of the oro-cecal segment (6.45 ± 0.4 vs 3.65 ± 1.55 pH units for healthy controls; P < 0.001), as well as during the entire oro-cecal segment (6.97 ± 0.4 vs 5.51 ± 1.1 pH units; P < 0.001). The same was evident for the median motility index (152 ± 64 vs 35.8 ± 31.1 mmHg*sec/min; P < 0.001 and 130 ± 65.9 vs 89.1 ± 20 mmHg*sec/min; P < 0.012, respectively). Median motility index was low the first hour of the colon (55.2 ± 45.7 vs 122 ± 77.9 mmHg*sec/min; P < 0.002). Additionally, patients had short oro-cecal transit time (5.8 ± 1.6 vs 7.6 ± 1.4 h; P < 0.001) and long colonic transit time (29.4 ± 17.5 vs 19.6 ± 12.2 h; P = 0.048). In patients with RYGB, the oro-cecal segment was characterized by an alkaline intraluminal environment, high motility activity, and short transit time. In contrast, colonic transit time was long.
Sections du résumé
BACKGROUND
Studies investigating the underlying pathophysiology are needed to help explain and understand the postoperative complications following Roux-en-Y gastric bypass (RYGB) surgery. This study aimed to characterize segmental gastrointestinal pH profiles, motility measures, and transit times in patients with RYGB.
MATERIALS AND METHODS
Nineteen patients with RYGB underwent a standardized wireless motility capsule assessment. The oro-cecal segment was defined from capsule ingestion until the passage of the ileocecal junction. Segmental median pH, motility index, and transit time were determined for the oro-cecal and colonic segment as well as for the first and last hour of both these segments. For comparison to reference values, data from 17 healthy age- and gender-matched controls was used. A mixed effect model was used to describe differences between groups.
RESULTS
Median pH was high in patients with RYGB during the first hour of the oro-cecal segment (6.45 ± 0.4 vs 3.65 ± 1.55 pH units for healthy controls; P < 0.001), as well as during the entire oro-cecal segment (6.97 ± 0.4 vs 5.51 ± 1.1 pH units; P < 0.001). The same was evident for the median motility index (152 ± 64 vs 35.8 ± 31.1 mmHg*sec/min; P < 0.001 and 130 ± 65.9 vs 89.1 ± 20 mmHg*sec/min; P < 0.012, respectively). Median motility index was low the first hour of the colon (55.2 ± 45.7 vs 122 ± 77.9 mmHg*sec/min; P < 0.002). Additionally, patients had short oro-cecal transit time (5.8 ± 1.6 vs 7.6 ± 1.4 h; P < 0.001) and long colonic transit time (29.4 ± 17.5 vs 19.6 ± 12.2 h; P = 0.048).
CONCLUSIONS
In patients with RYGB, the oro-cecal segment was characterized by an alkaline intraluminal environment, high motility activity, and short transit time. In contrast, colonic transit time was long.
Identifiants
pubmed: 33709293
doi: 10.1007/s11695-021-05308-x
pii: 10.1007/s11695-021-05308-x
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2632-2640Références
Tremmel M, Gerdtham U-G, Nilsson P, et al. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14:435.
pmcid: 5409636
doi: 10.3390/ijerph14040435
pubmed: 5409636
World Health Organization. Obesity and overweight. 2018 [cited 2019 Aug 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . Accessed 22 Aug 2020.
Sundhedsstyrelsen. National Klinisk Retningslinje for fedmekirurgi. Vol. 150, InPharma. 2013 [cited 2019 Apr 10]. 9–10 p. Available from: http://www.sst.dk . Accessed 10 April 2020.
Carlsson LMS, Sjöholm K, Jacobson P, et al. Life expectancy after bariatric surgery in the Swedish obese subjects study. N Engl J Med. 2020;383:1535–43.
pubmed: 33053284
pmcid: 7580786
doi: 10.1056/NEJMoa2002449
Dimitriadis GK, Randeva MS, Miras AD. Potential hormone mechanisms of bariatric surgery. Curr Obes Rep. 2017;6:253–65.
pubmed: 28780756
pmcid: 5585994
doi: 10.1007/s13679-017-0276-5
Seeras K, Lopez PP. Roux-en-Y gastric bypass chronic complications. StatPearls. 2019 [cited 2019 Jul 16];Available from: http://www.ncbi.nlm.nih.gov/pubmed/30137773 . Accessed 16 July 2020.
Angeles PC, Robertsen I, Seeberg LT, et al. The influence of bariatric surgery on oral drug bioavailability in patients with obesity: a systematic review. Obes Rev. 2019;20:1299–311.
pubmed: 31232513
pmcid: 6852510
doi: 10.1111/obr.12869
Hedberg J, Hedenström H, Sundbom M. Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: a novel use of the BRAVO™ system. Surg Endosc. 2011;25:2302–7.
pubmed: 21298531
doi: 10.1007/s00464-010-1553-5
Hedberg J, Hedenström H, Nilsson S, et al. Role of gastric acid in stomal ulcer after gastric bypass. Obes Surg. 2005;15:1375–8.
pubmed: 16354514
doi: 10.1381/096089205774859380
Mason EE, Munns JR, Kealey GP, et al. Effect of gastric bypass on gastric secretion. Surg Obes Relat Dis. 2005;1:155–60.
pubmed: 16925234
doi: 10.1016/j.soard.2005.02.014
Dirksen C, Damgaard M, Bojsen-Møller KN, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil. 2013;25:346–e255.
pubmed: 23360316
doi: 10.1111/nmo.12087
Nguyen NQ, Debreceni TL, Burgstad CM, et al. Effects of fat and protein preloads on pouch emptying, intestinal transit, glycaemia, gut hormones, glucose absorption, blood pressure and gastrointestinal symptoms after Roux-en-Y gastric bypass. Obes Surg. 2016;26:77–84.
pubmed: 25986427
doi: 10.1007/s11695-015-1722-7
Carswell KA, Vincent RP, Belgaumkar AP, et al. The effect of bariatric surgery on intestinal absorption and transit time. Obes Surg. 2014;24:796–805.
pubmed: 24374942
doi: 10.1007/s11695-013-1166-x
Wang G, Agenor K, Pizot J, et al. Accelerated gastric emptying but no carbohydrate malabsorption 1 year after gastric bypass surgery (GBP). Obes Surg. 2012;22:1263–7.
pubmed: 22527599
pmcid: 3659340
doi: 10.1007/s11695-012-0656-6
Morínigo R, Moizé V, Musri M, et al. Glucagon-Like Peptide-1, Peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006;91:1735–40.
pubmed: 16478824
doi: 10.1210/jc.2005-0904
Falkén Y, Hellström PM, Holst JJ, et al. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96:2227–35.
pubmed: 21543426
doi: 10.1210/jc.2010-2876
Sarosiek I, Selover KH, Katz LA, et al. The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology. Aliment Pharmacol Ther. 2010;31:313–22.
pubmed: 19814743
Wang YT, Mohammed SD, Farmer AD, et al. Regional gastrointestinal transit and pH studied in 215 healthy volunteers using the wireless motility capsule: influence of age, gender, study country and testing protocol. Aliment Pharmacol Ther. 2015;42:761–72.
pubmed: 26223837
doi: 10.1111/apt.13329
Farmer AD, Pedersen AG, Brock B, et al. Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile. Diabetologia. 2017;60:709–18.
pubmed: 28105520
doi: 10.1007/s00125-016-4199-6
Farmer AD, Wegeberg A-ML, Brock B, et al. Regional gastrointestinal contractility parameters using the wireless motility capsule: inter-observer reproducibility and influence of age, gender and study country. Aliment Pharmacol Ther. 2018;47:391–400.
pubmed: 29210098
doi: 10.1111/apt.14438
Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 3rd ed. Pearson/Prentice Hall: Upper Saddle River; 2009.
Abuhelwa AY, Williams DB, Upton RN, et al. Food, gastrointestinal pH, and models of oral drug absorption. Eur J Pharm Biopharm. 2017;112:234–48.
pubmed: 27914234
doi: 10.1016/j.ejpb.2016.11.034
Berg P, McCallum R. Dumping syndrome: a review of the current concepts of pathophysiology, diagnosis, and treatment. Dig Dis Sci. 2016;61:11–8.
pubmed: 26396002
doi: 10.1007/s10620-015-3839-x
Megan D. What is hypochlorhydria. Healthline Media. 2018 [cited 2019 Oct 2]. Available from: https://www.healthline.com/health/hypochlorhydria . Accessed 2 Oct 2020.
Camilleri M, Malagelada J-R. Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Investig. 1984;14:420–7.
doi: 10.1111/j.1365-2362.1984.tb01206.x
Faria M, Pavin EJ, Parisi MCR, et al. Delayed small intestinal transit in patients with long-standing type 1 diabetes mellitus: investigation of the relationships with clinical features, gastric emptying, psychological distress, and nutritional parameters. Diabetes Technol Ther. 2013;15:32–8.
pubmed: 23126582
doi: 10.1089/dia.2012.0158
Nguyen NQ, Debreceni TL, Burgstad CM, et al. Effects of posture and meal volume on gastric emptying, intestinal transit, oral glucose tolerance, blood pressure and gastrointestinal symptoms after Roux-en-Y gastric bypass. Obes Surg. 2015;25:1392–400.
pubmed: 25502436
doi: 10.1007/s11695-014-1531-4
Näslund I, Beckman K-W. Gastric emptying rate after gastric bypass and gastroplasty. Scand J Gastroenterol. 1987;22:193–201.
pubmed: 3554493
doi: 10.3109/00365528708991879
Jacobsen SH, Bojsen-Møller KN, Dirksen C, et al. Effects of gastric bypass surgery on glucose absorption and metabolism during a mixed meal in glucose-tolerant individuals. Diabetologia. 2013;56:2250–4.
pubmed: 23893303
doi: 10.1007/s00125-013-3003-0
Martinussen C, Bojsen-Møller KN, Dirksen C, et al. Augmented GLP-1 secretion as seen after gastric bypass may be obtained by delaying carbohydrate digestion. J Clin Endocrinol Metab. 2019;104:3233–44.
pubmed: 30844053
doi: 10.1210/jc.2018-02661
Bojsen-Møller KN, Jacobsen SH, Dirksen C, et al. Accelerated protein digestion and amino acid absorption after Roux-en-Y gastric bypass. Am J Clin Nutr. 2015;102:600–7.
pubmed: 26245808
doi: 10.3945/ajcn.115.109298
Farmer AD, Mohammed SD, Dukes GE, et al. Caecal pH is a biomarker of excessive colonic fermentation. World J Gastroenterol. 2014;20:5000–7.
pubmed: 24803812
pmcid: 4009533
doi: 10.3748/wjg.v20.i17.5000
Hasler WL, Saad RJ, Rao SS, et al. Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS. Am J Physiol Gastrointest Liver Physiol. 2009;297:G1107–14.
pubmed: 19808653
doi: 10.1152/ajpgi.00136.2009
Poulsen JL, Nilsson M, Brock C, et al. The impact of opioid treatment on regional gastrointestinal transit. J Neurogastroenterol Motil. 2016;22:282–91.
pubmed: 26811503
pmcid: 4819867
doi: 10.5056/jnm15175
Müller M, Canfora EE, Blaak EE. Gastrointestinal transit time, glucose homeostasis and metabolic health: modulation by dietary fibers. Nutrients. 2018;10:275.
pmcid: 5872693
doi: 10.3390/nu10030275
pubmed: 5872693
Afshar S, Kelly SB, Seymour K, et al. The effects of bariatric procedures on bowel habit. Obes Surg. 2016;26:2348–54.
pubmed: 26894909
pmcid: 5018031
doi: 10.1007/s11695-016-2100-9
Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18:1287–96.
pubmed: 18327626
doi: 10.1007/s11695-008-9456-4
Titus R, Kastenmeier A, Otterson MF. Consequences of gastrointestinal surgery on drug absorption. Nutr Clin Pract. 2013;28:429–36.
pubmed: 23835364
doi: 10.1177/0884533613490740
Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 2015;21:369–78.
pubmed: 25662404
pmcid: 25662404
doi: 10.1016/j.cmet.2015.01.001
Bohlin J, Dahlin E, Dreja J, et al. Longer colonic transit time is associated with laxative and drug use, lifestyle factors, and symptoms of constipation. Acta Radiol Open. 2018;7:205846011880723.
doi: 10.1177/2058460118807232
Roager HM, Hansen LBS, Bahl MI, et al. Colonic transit time is related to bacterial metabolism and mucosal turnover in the gut. Nat Microbiol. 2016;1:16093.
pubmed: 27562254
doi: 10.1038/nmicrobiol.2016.93
Saad RJ. The wireless motility capsule: a one-stop shop for the evaluation of GI motility disorders. Curr Gastroenterol Rep. 2016;18:14.
pubmed: 26908282
doi: 10.1007/s11894-016-0489-x
Wright RA, Krinsky S, Fleeman C, et al. Gastric emptying and obesity. Gastroenterology. 1983;84:747–51.
pubmed: 6825986
doi: 10.1016/0016-5085(83)90141-5
Al Mushref M, Srinivasan S. Effect of high fat-diet and obesity on gastrointestinal motility. Ann Transl Med. 2013;1:14.
pubmed: 24432301
pmcid: 3890396
Vazquez Roque MI, Camilleri M, Stephens DA, et al. Gastric sensorimotor functions and hormone profile in normal weight, overweight, and obese people. Gastroenterology. 2006;131:1717–24.
pubmed: 17087952
doi: 10.1053/j.gastro.2006.10.025
Doran S, Jones KL, Andrews JM, et al. Effects of meal volume and posture on gastric emptying of solids and appetite. Am J Physiol. 1998;275:R1712–8.
pubmed: 9791094
Velchik MG, Reynolds JC, Alavi A. The effect of meal energy content on gastric emptying. J Nucl Med. 1989;30:1106–10.
pubmed: 2738691