The Effect of Bariatric Surgery on Exocrine Pancreatic Function
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ORIGINAL CONTRIBUTIONS
The Effect of Bariatric Surgery on Exocrine Pancreatic Function M Mahir Ozmen 1
&
Emre Gundogdu 1 & Cem Emir Guldogan 1 & Fusun Ozmen 2
Received: 1 July 2020 / Revised: 26 August 2020 / Accepted: 26 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction After bariatric surgery (BS), patients might suffer from nutrient maldigestion, malabsorption, and vitamin deficiencies. In this study, our aim was to assess pancreatic functions after BS using fecal elastase-1 assay (FE-1). Material and Methods Sixty patients (21M) undergoing BS and 20 (6M) healthy controls were included into the study. Stool samples were collected 1 year after surgery. Ten patients from one anastomosis gastric bypass (OAGB) and single anastomosis duodenal switch (SADS) groups with the lowest value of FE-1 and GIQLI scores were given pancreatic enzyme replacement therapy (PERT). After PERT, FE-1, excess weight loss (EWL), BMI, GIQLI scores, and vitamin D levels were measured. Results Vitamin D levels were detected as 19.04 (9–46.5) pg/ml, 15.1 (8.4–23.6) pg/ml, 17.8 (5–30) pg/ml, and 21.79 (11–40.3) pg/ml after sleeve gastrectomy (SG), OAGB, SADS, and control groups, respectively (p = 0.04). GIQLI scores in the first year were found to have increased in all patients (p = 0.02). FE-1 levels were found as 642.35 (566.3–711.4) μg/g, 378.52 (183.5– 561.1) μg/g, 458.88 (252.5–593, 5) μg/g, and 518.2 (351.6–691) μg/g for the SG, OAGB, SADS, and control groups, respectively. There was a strong inverse correlation between EWL and FE-1 levels at the end of the first year (Spearman’s rho = − 0.688, p = 0.003). After having performed PERT for patients with the lowest FE-1 levels, the levels increased to 683.39 (615.5– 720) μg/g in the OAGB and 691.5 (643.1–720) μg/g in the SADS groups (p = 0.011). Conclusion FE-1 measurements demonstrated that many patients suffer from malabsorption after OAGB or SADS, whereas functions remain normal after SG. PERT corrects pancreatic functions without affecting weight loss and also contributes to the normal serum level of vitamin D. Keywords Bariatric surgery . Exocrine pancreatic function . Exocrine pancreatic insufficiency . Pancreatic enzyme replacement therapy . Fecal elastase-1
Introduction The pancreas is the second largest organ of the digestive system after the liver with exocrine/endocrine functions. While sodium bicarbonate (ductal function) and digestive enzymes are secreted by the exocrine pancreas into the duodenum, the endocrine pancreas secretes many hormones into circulation, especially This study was presented at the ASMBS, Obesity Week, 11–15 November 2018, Nashville, TN, USA * M Mahir Ozmen [email protected] 1
Department of Surgery, School of Medicine, Istinye University, Istanbul, Türkiye
2
Department of Basic Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
those that regulate glucose metabolism [1]. The majority of the pancreas consists of exocrine cells while 10% show endocrine cell function. The d
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