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

Abstract

Background Bariatric surgery contributes to the improvement in glucose metabolism that may be related to a postoperative increase in serum bile acids (BAs). Three commonly used types of bariatric procedures, laparoscopic sleeve gastrectomy (LSG) (without creation of a bile loop), Roux-en-Y gastric bypass (RYGB), and omega-loop gastric bypass (OLGB) (with creation of shorter 100-150 cm and longer 200-280 cm bile loops, respectively), differ in their effects on glycemic control. The aim of the study was to compare the effects of various bariatric procedures on serum BA concentration and glucose homeostasis. Methods Serum BAs in 26 obese patients were determined by liquid chromatography-mass spectrometry prior to bariatric surgery, as well as 4 days and 3 months thereafter. Results Four days after the surgery, serum concentrations of BAs in LSG and OLGB groups were similar as prior to the procedure, and a slight decrease in serum BAs was observed in the RYGB group. Serum BA level in the LSG group remained unchanged also at 3 months after the surgery, whereas a significant 0.5-and 3-fold increase in this parameter was noted in the RYGB and OLGB groups, respectively. Serum concentration of BAs correlated positively with the length of the bile loop (R = 0.47, p < 0.05). Conclusion The evident improvement of glycemic control observed 3 months after OLGB might be associated with a postoperative increase in serum BAs, resulting from their better absorption from the longer bile loop. However, the changes in serum BAs probably had little or no impact on insulin sensitivity improvement at 4 days post-surgery.

One Anastomosis Gastric Bypass Reconstitutes the Appropriate Profile of Serum Amino Acids in Patients with Morbid Obesity

“…At present, the most effective is BS. OAGB is a bariatric procedure that improves metabolic parameters [5], causes remission of type 2 diabetes mellitus [4], and is associated with low morbidity [22].…”

Role of Bile Acids in Bariatric Surgery

“…It has been speculated that the length ratio of the biliopancreatic limb and the common limb represent a major determinant of postoperative serum bile acid concentrations. Postoperative serum bile acid concentrations are likely to be greater with longer biliopancreatic limb and shorter common limb, as evidenced by both animal (Han et al, 2015; Miyachi et al, 2016) and human studies (Mika et al, 2018). The precise mechanism has yet been elucidated.…”

The Effect of One Anastomosis Gastric Bypass on Branched-Chain Fatty Acid and Branched-Chain Amino Acid Metabolism in Subjects with Morbid Obesity

“…Bariatric surgery brings about significant alterations in lipid metabolism, but the exact nature of these changes depends on the surgical procedure [3]. One anastomosis gastric bypass (OAGB) is a promising type of bariatric surgery that improves metabolic parameters (reduction in serum concentrations of triglycerides, total and LDL cholesterol, and C-reactive protein; and increase in HDL cholesterol concentration) [4], causes remission of type 2 diabetes mellitus, and is associated with relatively low morbidity [5,6]. However, some studies found higher incidence of diarrhea, steatorrhea, and nutritional adverse events after OAGB than after RYGB [7].…”

“…Reduced food intake after surgery may result in deficiencies of some important nutrients [8], such as bioactive lipids which, although present in small amounts in the diet, are vital for many physiological functions. On the other hand, bariatric surgery may lead to an increase in serum concentrations of some other lipid classes, e.g., bile acids [3,4,9].…”