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Gastric Emptying and Postprandial PYY Response After Biliopancreatic Diversion with Duodenal Switch
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. (Klinisk Fysiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Endokrinologi, diabetes och metabolism)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Endokrinologi, diabetes och metabolism)
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2011 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 21, no 5, 609-615 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Super-obesity (BMI > 50) is increasing rapidly. We use the biliopancreatic diversion with duodenal switch (BPD-DS) as one option in this patient category. The aim of the present study was to investigate the emptying of the gastric tube, PYY levels and dumping symptoms after BPD-DS.

METHODS: Emptying of the gastric tube was investigated with scintigraphy after an overnight fast. Twenty patients (median age 43 years, BMI 31.1 kg/m(2)) having undergone BPD-DS in median 3.5 years previously were included in the scintigraphic study. A technetium-labelled omelette was ingested and scintigraphic evaluation of gastric emptying was undertaken. Ten of the patients also underwent PYY measurements after a standardised meal and were compared to nine non-operated age-matched normal weight controls, both in the fasting state and after the test meal. Frequency of dumping symptoms was evaluated in all patients.

RESULTS: The half-emptying time was 28 ± 16 min. Lag phase was present in 30% of the patients. PYY levels were significantly higher in BPD-DS patients as compared to controls both in the fasting state (p < 0.001) and after the test meal (p < 0.001). Dumping symptoms were scarce and occurred in 17 of the 20 patients only few times yearly or less.

CONCLUSIONS: Although the pylorus is preserved in BPD-DS, the stomach emptying is faster than in non-operated subjects. PYY levels are elevated in the fasting state after BPD-DS and a marked response to a test meal is seen, likely due to the rapid stimulation of intraluminal nutrients in the distal ileum. In spite of this, dumping symptoms are uncommon.

Place, publisher, year, edition, pages
2011. Vol. 21, no 5, 609-615 p.
Keyword [en]
Duodenal switch, Gastric emptying, PYY, Scintigraphy, Morbid obesity, Dumping
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-131876DOI: 10.1007/s11695-010-0288-7ISI: 000289114300011PubMedID: 20862615OAI: oai:DiVA.org:uu-131876DiVA: diva2:355974
Available from: 2010-10-08 Created: 2010-10-08 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Gastrointestinal Physiology and Results following Bariatric Surgery
Open this publication in new window or tab >>Gastrointestinal Physiology and Results following Bariatric Surgery
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The number of operations for morbid obesity is rising fast. We have examined aspects of postoperative physiology and results after bariatric surgery.

The pH in the proximal pouch after Roux-en-Y gastric bypass (RYGBP) was investigated with catheter-based and wire-less technique. Gastric emptying, PYY-levels in the fasting state and after a standardized meal was evaluated after biliopancreatic diversion with duodenal switch (DS). A clinical trial was undertaken, comparing DS to RYGBP in patients with BMI>48. Main outcome variables were safety and long-term weight results as well as abdominal symptoms and laboratory results.

Patients with stomal ulcer had significantly lower pH in their proximal gastric pouch as compared to asymptomatic control subjects. Long-time pH measurements with the wire-less BRAVO-system were feasible and demonstrated pH<4 in median 10.5% of the time in asymptomatic post-RYGBP patients. After DS, the T50 of gastric emptying was 28±16 minutes. PYY-levels were higher after DS than in age-matched control subjects. BMI-reduction was greater after DS (24 BMI-units) than after RYGBP (17 BMI-units) in median 3.5 (2.0-5.3) years after surgery (p<0.001). Fasting glucose and HbA1c levels were lower one and three years after DS as compared to RYGBP. On the other hand, DS-patients reported having more diarrhea and malodorous flatus.

This thesis has resulted in deepened knowledge. Acid produced in the proximal pouch is an important pathogenetic factor in the development of stomal ulcer after RYGBP. However, symptom-free patients have an acidic environment in the proximal Roux-limb as well. After DS, gastric emptying is fast, but not instantaneous, and PYY-levels are high. DS results in superior weight reduction and better glucose control as compared to RYGBP in patients with BMI>48. We believe that DS has a place in surgical treatment of the super-obese, even though symptoms of diarrhea and malodorous flatus are more common after DS.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 607
Keyword
Bariatric surgery, gastric bypass, biliopancreatic diversion with duodenal switch, PYY, stomal ulcer, gastric emptying
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-131889 (URN)978-91-554-7916-9 (ISBN)
Public defence
2010-11-27, Grönwallsalen, Ing 70 Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
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Supervisors
Available from: 2010-11-04 Created: 2010-10-09 Last updated: 2011-01-13Bibliographically approved

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Hedberg, JakobHedenström, HansSundbom, Magnus

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