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Changes in Intestinal Permeability after Roux-en-Y Gastric Bypass

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) interferes considerably with the anatomy and physiology of the gastrointestinal tract. The study of intestinal permeability can provide important information regarding changes in the structure and function of the mucosal barrier after the procedure.

Methods

The urinary excretion rates of lactulose and mannitol after oral intake of both substances were evaluated. We also evaluated the lactulose/mannitol excretion ratio. Tests were performed during the preoperative period (T0), at the first postoperative month (T1), and at the sixth postoperative month (T6).

Results

The study included 16 morbidly obese patients. The excretion rate of mannitol was significantly lower at T1 compared with T0 and T6 (p = 0.003). There was no significant difference in the excretion rates of lactulose or in the lactulose/mannitol ratio during the three periods. Six patients (37.5 %) exhibited a considerable increase in the excretion rate of lactulose at T6 (4–73 times higher than the preoperative value), accompanied by proportional variations in the lactulose/mannitol ratio.

Conclusions

The significant increase in mannitol excretion rate from T1 to T6 most likely reflects the occurrence of intestinal adaptation (mucosal hyperplasia), which would tend to minimize the malabsorption of macronutrients. A subgroup of patients who undergo RYGB exhibit pronounced increase in their intestinal permeability (assessed by the lactulose/mannitol ratio and the lactulose excretion rate) at T6.

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Conflicts of interest

Alexandre Lages Savassi-Rocha, Marco Túlio Costa Diniz, Eduardo Garcia Vilela, Maria de Fátima Haueisen Sander Diniz, Soraya Rodrigues de Almeida Sanches, Aloísio Sales da Cunha, Maria de Lourdes de Abreu Ferrari, Henrique Oswaldo da Gama Torres, Bruno Antonio Maciente, Gabriela Santana Ataliba, Paloma Maciel Araújo, Taciana Bretas Guerra, and Inara Kellen Fonseca Balbino declare no conflict of interest.

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Authors and Affiliations

  1. Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Bernardo Monteiro, 1397/802, 30150-281, Belo Horizonte, Minas Gerais, Brazil

    Alexandre Lages Savassi-Rocha, Marco Túlio Costa Diniz, Eduardo Garcia Vilela, Soraya Rodrigues de Almeida Sanches, Aloísio Sales da Cunha & Maria de Lourdes de Abreu Ferrari

  2. Departamento de Clínica Médica, Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Eduardo Garcia Vilela, Maria de Fátima Haueisen Sander Diniz, Aloísio Sales da Cunha, Maria de Lourdes de Abreu Ferrari & Henrique Oswaldo da Gama Torres

  3. Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Marco Túlio Costa Diniz & Soraya Rodrigues de Almeida Sanches

  4. Serviço de Endocrinologia e Metabologia, Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Maria de Fátima Haueisen Sander Diniz

  5. Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Bruno Antonio Maciente, Gabriela Santana Ataliba, Paloma Maciel Araújo & Taciana Bretas Guerra

  6. Faculdade IBMEC, Belo Horizonte, Minas Gerais, Brazil

    Inara Kellen Fonseca Balbino

Authors
  1. Alexandre Lages Savassi-Rocha
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  2. Marco Túlio Costa Diniz
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  3. Eduardo Garcia Vilela
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  6. Aloísio Sales da Cunha
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  7. Maria de Lourdes de Abreu Ferrari
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  13. Inara Kellen Fonseca Balbino
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Correspondence to Alexandre Lages Savassi-Rocha.

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Savassi-Rocha, A.L., Diniz, M.T.C., Vilela, E.G. et al. Changes in Intestinal Permeability after Roux-en-Y Gastric Bypass. OBES SURG 24, 184–190 (2014). https://doi.org/10.1007/s11695-013-1084-y

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