Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: a novel use of the BRAVO™ system

Hedberg, Jakob; Hedenström, Hans; Sundbom, Magnus

doi:10.1007/s00464-010-1553-5

Cited by 12 publications

(6 citation statements)

References 30 publications

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“…In our previous measurements, just below the gastrojejunal anastomosis, in 21 RYGBP-patients, median percentage of time with pH < 4 was 10.5% [18], compared to 13.0% in the present study. Although the large gastric remnant in DS results in high acidity (68.7% of the time with pH < 4), the alkaline mucus produced by the Brunner’s glands, located in the first few centimeters of the duodenum, manages to keep the pH in the small bowel on almost the same level as in RYGBP.…”

Section: Discussioncontrasting

confidence: 67%

“…Moreover, intragastric and duodenal pH monitoring has been implemented with BRAVO™ system with good reliability and promising results [11–17]. We have previous experience in measuring pH in the jejunum, just below the level of gastrojejunal anastomosis in RYGBP, where pH was below four in 10.5 (0.3–37.7) percent of the time during more than 24 h of continuous registration [18]. …”

Section: Introductionmentioning

confidence: 99%

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Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study

et al. 2017

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IntroductionBariatric procedures result in massive weight loss, however, not without side effects. Gastric acid is known to cause marginal ulcers, situated in the small bowel just distal to the upper anastomosis. We have used the wireless BRAVO™ system to study the buffering effect of the duodenal bulb in duodenal switch (DS), a procedure in which the gastric sleeve produces a substantial amount of acid.MethodsWe placed a pre- and a postpyloric pH capsule in 15 DS-patients (seven men, 44 years, BMI 33) under endoscopic guidance and verified the correct location by fluoroscopy. Patients were asked to eat and drink at their leisure, and to register their meals for the next 24 h.ResultsAll capsules but one could be successfully placed, without complications. Total registration time was 17.2 (1.3–24) hours prepyloric and 23.1 (1.2–24) hours postpyloric, with a corresponding pH of 2.66 (1.74–5.81) and 5.79 (4.75–7.58), p < 0.01. The difference in pH between the two locations was reduced from 3.55 before meals to 1.82 during meals, p < 0.01. Percentage of time with pH < 4 was 70.0 (19.9–92.0) and 13.0 (0.0–34.6) pre and postpylorically, demonstrating a large buffering effect.ConclusionBy this wireless pH-metric technique, we could demonstrate that the duodenal bulb had a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. This physiologic effect could explain the low incidence of stomal ulcers.

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Section: Discussioncontrasting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study

et al. 2017

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“…Whether the increased expression of H + /K + -ATPase β subunit associated with an increased number of parietal cells, correspond to a recovery of acid-secretory capacities of the enlarged parietal cells after VSG and RYGB will be the matter of future studies. We speculate that, after RYGB, in the absence of the duodenum intrinsic acid-buffering properties, the increased parietal cells expressing H + /K + -ATPase in GP could induce hyperacidity delivered directly in the jejunum lumen that may contribute to anastomotic ulcers (sensitive to proton inhibitors), a recognized complication in some RYGB patients [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Remodeling of the Residual Gastric Mucosa after Roux-En-Y Gastric Bypass or Vertical Sleeve Gastrectomy in Diet-Induced Obese Rats

et al. 2015

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Whereas the remodeling of intestinal mucosa after bariatric surgeries has been the matter of numerous studies to our knowledge, very few reported on the remodeling of the residual gastric mucosa. In this study, we analyzed remodeling of gastric mucosa after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in rats. Diet-induced obese rats were subjected to RYGB, VSG or sham surgical procedures. All animals were assessed for food intake, body-weight, fasting blood, metabolites and hormones profiling, as well as insulin and glucose tolerance tests before and up to 5 weeks post-surgery. Remodeling of gastric tissues was analyzed by routine histology and immunohistochemistry studies, and qRT-PCR analyses of ghrelin and gastrin mRNA levels. In obese rats with impaired glucose tolerance, VSG and RYGB caused substantial weight loss and rats greatly improved their oral glucose tolerance. The remaining gastric mucosa after VSG and gastric pouch (GP) after RYGB revealed a hyperplasia of the mucous neck cells that displayed a strong immunoreactivity for parietal cell H+/K+-ATPase. Ghrelin mRNA levels were reduced by 2-fold in remaining fundic mucosa after VSG and 10-fold in GP after RYGB. In the antrum, gastrin mRNA levels were reduced after VSG in line with the reduced number of gastrin positive cells. This study reports novel and important observations dealing with the remaining gastric mucosa after RYGB and VSG. The data demonstrate, for the first time, a hyperplasia of the mucous neck cells, a transit cell population of the stomach bearing differentiating capacities into zymogenic and peptic cells.

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“…In addition, no major differences between the two controlled‐release formulations were demonstrated, thus approving bioequivalence in persons with a healthy gastrointestinal tract 7 . However, this may not apply to patients with RYGB, where gastric pH is more alkaline, 8,9 oro‐cecal transit and gastric mixing reduced 10 and biliopancreatic secretion suppressed, 11,12 thus potentially altering drug release, absorption and influencing the PKPD relationship of different controlled‐release tablets 13–15 …”

Section: Introductionmentioning

confidence: 99%

Effect of Roux‐en‐Y gastric bypass on the pharmacokinetic‐pharmacodynamic relationships of liquid and controlled‐release formulations of oxycodone

Ladebo

Abuhelwa

Foster

et al. 2021

Basic Clin Pharma Tox

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The physiological changes following Roux‐en‐Y gastric bypass (RYGB) surgery may impact drug release from mechanistically different controlled‐release tablets, making generic substitution inappropriate. This study aimed to characterise the pharmacokinetic‐pharmacodynamic relationships of oxycodone from a lipid‐based and water‐swellable controlled‐release tablet in RYGB patients. Twenty RYGB patients received 10‐mg oral solution oxycodone or 20‐mg controlled‐release (water‐swellable or lipid‐based) oxycodone in a three‐way, randomised, semiblinded and cross‐over study. Blood sampling and pupillary recordings were conducted over a 24‐h period. A previously established pharmacokinetic‐pharmacodynamic model of these three formulations in healthy volunteers was used in the analysis as a reference model. No differences in absorption kinetics were seen between controlled‐release formulations in patients. However, the absorption lag time was 11.5 min in patients vs 14 min in healthy volunteers for controlled‐release tablets (P < 0.001). Furthermore, oral bioavailability was 14.4% higher in patients compared to healthy volunteers regardless of formulation type (P < 0.001). Oxycodone pharmacodynamics were not significantly affected by formulation or patient status. However, baseline pupil diameter was inversely correlated with age (P < 0.001) and plasma concentrations of oxycodone at half‐maximum effect were 31% lower in males compared to females (P < 0.05). Generic substitution of monophasic lipid‐based and water‐swellable controlled‐release oxycodone tablets may be considered safe in RYGB patients.

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Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: a novel use of the BRAVO™ system

Cited by 12 publications

References 30 publications

Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study

Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study

Remodeling of the Residual Gastric Mucosa after Roux-En-Y Gastric Bypass or Vertical Sleeve Gastrectomy in Diet-Induced Obese Rats

Effect of Roux‐en‐Y gastric bypass on the pharmacokinetic‐pharmacodynamic relationships of liquid and controlled‐release formulations of oxycodone

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