Bile acid profiles over 5 years after gastric bypass and duodenal switch: results from a randomized clinical trial

Abstract

(2017). Bile acid profiles over 5 years following gastric bypass and duodenal switch -Results from a randomized clinical trial. Surgery for obesity and related diseases. https://doi.org/10.1016/j.soard.2017.05.024Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rightsCopyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.•You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to the work immediately and investigate your claim. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Evidence That the Length of Bile Loop Determines Serum Bile Acid Concentration and Glycemic Control After Bariatric Surgery

“…Our findings are partially consistent with the results published recently by Risstad et al [26]; according to these authors, the increase in total serum BAs in obese patients subjected to biliopancreatic diversion with duodenal switch (BPD/DS) was greater than that in individuals after RYGB. Similar to OLGB, BPD/DS also results in a longer passage of concentrated bile via the biliopancreatic limb.…”

“…Similar to OLGB, BPD/DS also results in a longer passage of concentrated bile via the biliopancreatic limb. Unfortunately, Risstad et al did not analyze the link between serum concentration of BAs and biliary loop length [26]. The importance of the latter parameter as a determinant of serum BA level after bariatric surgery was also demonstrated in an animal study in which an increase in bile acid concentration and improvement of glucose metabolism were observed in rats with longer biliopancreatic limb, but not in those with the shorter limb [27].…”

Bile acid changes after metabolic surgery are linked to improvement in insulin sensitivity

“…The results, moreover, showed an increase in fasting circulating levels of both primary and secondary bile acids and almost all individual bile acids after BPD and RYGB. These results are in line with some previous studies showing increases in total fasting bile acid concentrations after RYGB and BPD. A previous study, however, reported an early decrease in total bile acid levels after RYGB, whereas some metabolic procedures, such as banding and sleeve gastrectomy, did not appear to affect total bile acid levels.…”

“…Metabolic surgery procedures in which the bile is diverted distally in the ileum, such as BPD, should modify the bile acid pool to a greater extent than less malabsorptive procedures, such as RYGB, where the bile is diverted into the proximal jejunum. Differences in circulating bile acid levels between BPD and RYGB have been reported in humans but BPD and RYGB groups in the present study showed remarkably similar fasting bile acid levels and profiles. Interestingly, a previous study in the rat suggested that bile diversion in the mid‐jejunum and in the mid‐ileum led to the same level of plasma bile acids and improvement in glucose tolerance, which supports the present results and suggests that the length of the alimentary limb does not have a major role in determining the increased bile acid levels after metabolic surgery.…”

“…Interestingly, an alternative hypothesis, with insulin resistance driving the production of bile acids, was suggested after a positive correlation was found between 12‐α‐hydroxylated bile acids and the homeostatic model assessment for insulin resistance. In some studies of bile acids and metabolic surgery, however, no links between changes in bile acids and insulin sensitivity were found. Hence, the effect of bile acid changes on insulin sensitivity after metabolic surgery is still unclear, but the present results suggest a potential role of conjugated secondary bile acids in the amelioration of insulin sensitivity.…”