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, 20 (10), 1408-14

Is the Roux Limb a Determinant for Meal Size After Gastric Bypass Surgery?

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Is the Roux Limb a Determinant for Meal Size After Gastric Bypass Surgery?

Per Björklund et al. Obes Surg.

Abstract

The Roux-Y gastric bypass (RYGBP) is an effective weight-reducing procedure but the involved mechanisms of action are obscure. The Roux limb is the intestinal segment that following surgery is the primary recipient for food intake. The aims of the study were to explore the mechanosensory and biomechanical properties of the Roux limb and to make correlations with preferred meal size. Ten patients participated and were examined preoperatively, 6 weeks and 1 year after RYGBP. Each subject ingested unrestricted amounts of a standardized meal and the weight of the meal was recorded. On another study day, the Roux limb was subjected to gradual distension by the use of an intraluminal balloon. Luminal volume-pressure relationships and thresholds for induction of sensations were monitored. At 6 weeks and 1 year post surgery, the subjects had reduced their meal sizes by 62% and 41% (medians), respectively, compared to preoperative values. The thresholds for eliciting distension-induced sensations were strongly and negatively correlated to the preferred meal size. Intraluminal pressure during Roux limb distension, both at low and high balloon volumes, correlated negatively to the size of the meal that the patients had chosen to eat. The results suggest that the Roux limb is an important determinant for regulating food intake after Roux-Y bypass bariatric surgery.

Figures

Fig. 1
Fig. 1
Location of the catheter in the Roux limb. Note that the position of the balloon was standardized using recordings of transmucosal potential difference (TMPD) at the indicated side holes along the esophago-gastro-Roux axis
Fig. 2
Fig. 2
Individual values of body mass index (BMI) (upper panel) and the preferred meal size (lower panel) at each study day before as well as 6 weeks and 1 year after RYGBP surgery
Fig. 3
Fig. 3
Intraluminal pressure in the Roux limb following balloon distension with consecutively increased volumes. Ten subjects were enrolled and dropouts due to perceived discomfort during the distension protocol are indicated by n value. Data are given as means ± SEM
Fig. 4
Fig. 4
The recorded thresholds for induction of non-pain sensations in response to distension of the Roux limb plotted against preferred meal size. Data collected 6 weeks after RYGBP
Fig. 5
Fig. 5
Baseline intraluminal pressures at a balloon volume of 20 mL (a) and at the highest recorded pressure in each individual (b) plotted against preferred meal size

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