Effects of Posture and Meal Volume on Gastric Emptying, Intestinal Transit, Oral Glucose Tolerance, Blood Pressure and Gastrointestinal Symptoms After Roux-en-Y Gastric Bypass

• Published in: Obesity surgery Vol. 25; no. 8; pp. 1392 - 1400
• Main Authors: Nguyen, Nam Q., Debreceni, Tamara L., Burgstad, Carly M., Wishart, Judith M., Bellon, Max, Rayner, Chris K., Wittert, Gary A., Horowitz, Michael
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2015; Springer Nature B.V
• Subjects: Adult; Blood Glucose - metabolism; Blood pressure; Blood Pressure - physiology; Bypass; Female; Food; Gastric Bypass - adverse effects; Gastric Emptying - physiology; Gastrointestinal diseases; Gastrointestinal Diseases - epidemiology; Gastrointestinal Diseases - etiology; Gastrointestinal surgery; Gastrointestinal Transit - physiology; Glucose; Glucose Tolerance Test; Humans; Insulin - blood; Male; Meals - physiology; Medicine; Medicine & Public Health; Middle Aged; Obesity, Morbid - epidemiology; Obesity, Morbid - physiopathology; Obesity, Morbid - surgery; Original Contributions; Postprandial Period; Posture; Posture - physiology; Random Allocation; Surgery; Pouch; Glucose absorption; Gastric emptying; Roux-en-Y gastric bypass; Gastrointestinal hormones; Posture
• ISSN: 0960-8923; 1708-0428; 1708-0428
• DOI: 10.1007/s11695-014-1531-4

Background The purpose of this study is to determine the effects of posture and drink volume on gastric/pouch emptying (G/PE), intestinal transit, hormones, absorption, glycaemia, blood pressure and gastrointestinal (GI) symptoms after gastric bypass (Roux-en-Y gastric bypass (RYGB)). Methods Ten RYGB subjects were studied on four occasions in randomized order (sitting vs. supine posture; 50 vs. 150 ml of labelled water mixed with 3 g 3- O -methyl- d- glucose (3-OMG) and 50 g glucose). G/PE, caecal arrival time (CAT), blood glucose, plasma insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), peptide YY (PYY), 3-OMG, blood pressure, heart rate and GI symptoms were assessed over 240 min. Controls were ten volunteers with no medical condition or previous abdominal surgery, who were studied with the 150-ml drink in the sitting position. Results Compared to controls, PE ( P  < 0.001) and CAT ( P  < 0.001) were substantially more rapid in RYGB subjects. In RYGB, PE was more rapid in the sitting position (2.5 ± 0.7 vs. 16.6 ± 5.3 min, P  = 0.02) and tends to be faster after 150 ml than the 50-ml drinks (9.5 ± 2.9 vs. 14.0 ± 3.5 min, P  = 0.16). The sitting position and larger volume drinks were associated with greater releases of insulin, GLP-1 and PYY, as well as more hypotension ( P  < 0.01), tachycardia ( P  < 0.01) and postprandial symptoms ( P  < 0.001). Conclusions Pouch emptying, blood pressure and GI symptoms after RYGB are dependent on both posture and meal volume.