University of Oulu

Härma, M.-A., Adeshara, K., Istomin, N., Lehto, M., Blaut, M., Savolainen, M. J., Hörkkö, S., Groop, P.-H., Koivukangas, V., & Hukkanen, J. (2021). Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes. Surgery for Obesity and Related Diseases, 17(3), 585–594.

Gastrointestinal manifestations after Roux-en-Y gastric bypass surgery in individuals with and without type 2 diabetes

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Author: Härma, Mari-Anne1,2,3; Adeshara, Krishna1,2,3; Istomin, Natalie4,5,6;
Organizations: 1Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
2Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Helsinki, Finland
4Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Nordlab, Oulu University Hospital, Oulu, Finland
7Department of Gastrointestinal Microbiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
8Research Unit of Internal Medicine and Biocenter Oulu, University of Oulu, Oulu, Finland
9Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
10Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 2.7 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2021-10-22


Background: Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity, which improves cardiovascular health and reduces the risk of premature mortality. However, some reports have suggested that RYGB may predispose patients to adverse health outcomes, such as inflammatory bowel disease (IBD) and colorectal cancer.

Objectives: The present prospective study aimed to evaluate the impact of RYGB surgery on cardiovascular risk factors and gastrointestinal inflammation in individuals with and without type 2 diabetes (T2D).

Setting: University hospital setting in Finland.

Methods: Blood and fecal samples were collected at baseline and 6 months after surgery from 30 individuals, of which 16 had T2D and 14 were nondiabetics. There were also single study visits for 6 healthy reference patients. Changes in cardiovascular risk factors, serum cholesterol, and triglycerides were investigated before and after surgery. Fecal samples were analyzed for calprotectin, anti-Saccharomyces cerevisiae immunoglobulin A antibodies (ASCA), active lipopolysaccharide (LPS) concentration, short-chain fatty acids (SCFAs), intestinal alkaline phosphatase activity, and methylglyoxal-hydro-imidazolone (MG-H1) protein adducts formation.

Results: After RYGB, weight decreased on average −21.6% (−27.2 ± 7.8 kg), excess weight loss averaged 51%, and there were improvements in cardiovascular risk factors. Fecal calprotectin levels (P < 0.001), active LPS concentration (P < 0.002), ASCA (P < 0.02), and MG-H1 (P < 0.02) values increased significantly, whereas fecal SCFAs, especially acetate (P < 0.002) and butyrate (P < 0.03) levels, were significantly lowered.

Conclusion: The intestinal homeostasis is altered after RYGB, with several fecal markers suggesting increased inflammation; however, clinical significance of the detected changes is currently uncertain. As chronic inflammation may predispose patients to adverse health effects, our findings may have relevance for the suggested association between RYGB and increased risks of incident IBD and colorectal cancer.

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Series: Surgery for obesity and related diseases
ISSN: 1550-7289
ISSN-E: 1878-7533
ISSN-L: 1550-7289
Volume: 17
Issue: 3
Pages: 585 - 594
DOI: 10.1016/j.soard.2020.10.021
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Yrjö Jahnsson Foundation (20197174), Academy of Finland (275614, 316664, and 315568), Novo Nordisk Foundation (#NNF OC0013659), Signe and Ane Gyllenberg Foundation, Folkhälsan Research Foundation, Helsinki University Central Hospital Research Funds, the Diabetes Research Foundation, the Päivikki and Sakari Sohlberg Foundation, the Finnish Foundation for Cardiovascular Research, the Northern Finland Health Care Support Foundation, the Finnish Medical Foundation, and Wilhelm and Else Stockmann Foundation supported this study.
Copyright information: © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license