Metabolic improvement in obese patients after duodenal-jejunal exclusion is associated with intestinal microbiota composition changes

Int J Obes (Lond). 2019 Dec;43(12):2509-2517. doi: 10.1038/s41366-019-0336-x. Epub 2019 Feb 14.


Background: Intestinal microbiota have been suggested to play an important role in the pathogenesis of obesity and type 2 diabetes. Bariatric surgery improves both conditions and has been associated with changes in intestinal microbiota composition. We investigated the effect of a nonsurgical bariatric technique on intestinal microbiota composition in relation to metabolic improvement.

Methods: Seventeen patients with obesity and type 2 diabetes were treated with the nonsurgical duodenal-jejunal bypass liner, which excludes the proximal 60 cm small intestine from food. Fecal samples as well as metabolic parameters reflecting obesity and type 2 diabetes were obtained from the patients at baseline, after 6 months with the device in situ, and 6 months after explantation.

Results: After 6 months of treatment, both obesity and type 2 diabetes had improved with a decrease in weight from 106.1 [99.4-123.5] to 97.4 [89.4-114.0] kg and a decrease in HbA1c from 8.5% [7.6-9.2] to 7.2% [6.3-8.1] (both p < 0.05). This was paralleled by an increased abundance of typical small intestinal bacteria such as Proteobacteria, Veillonella, and Lactobacillus spp. in feces. After removal of the duodenal-jejunal bypass liner, fecal microbiota composition was similar to that observed at baseline, despite persistent weight loss.

Conclusion: Improvement of obesity and type 2 diabetes after exclusion of the proximal 60 cm small intestine by treatment with a nonsurgical duodenal-jejunal bypass liner may be promoted by changes in fecal microbiota composition.

MeSH terms

  • Adult
  • Bariatrics* / methods
  • Bariatrics* / statistics & numerical data
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / therapy
  • Duodenum / physiology*
  • Feces / microbiology
  • Female
  • Gastrointestinal Microbiome / physiology*
  • Humans
  • Jejunum / physiology*
  • Male
  • Middle Aged
  • Obesity* / physiopathology
  • Obesity* / therapy
  • Treatment Outcome
  • Young Adult