Jennifer Wilbrink1,2,3,4, Nienke Bernards5, Zlatan Mujagic6,7, Mark van Avesaat6,7, Kirsten Pijls6,7, Tim Klaassen6,7, Hans van Eijk8, Simon Nienhuijs9, Arnold Stronkhorst5, Ellen Wilms6,7, Freddy Troost6,7, Ad Masclee6,7. 1. Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. j.wilbrink@zuyderland.nl. 2. Department of Gastroenterology-Hepatology, Catharina Hospital, Eindhoven, The Netherlands. j.wilbrink@zuyderland.nl. 3. Department of Gastroenterology-Hepatology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The Netherlands. j.wilbrink@zuyderland.nl. 4. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. j.wilbrink@zuyderland.nl. 5. Department of Gastroenterology-Hepatology, Catharina Hospital, Eindhoven, The Netherlands. 6. Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. 7. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. 8. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 9. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Abstract
BACKGROUND: Obesity has been associated with impaired intestinal barrier function. It is not known whether bariatric surgery leads to changes in intestinal barrier function. We hypothesized that obesity is associated with disturbances in gastrointestinal barrier function, and that after bariatric surgery barrier function will improve. METHODS: Prospective single center study in which we assessed segmental gut permeability by urinary recovery of a multisugar drink in 27 morbidly obese (BMI 43.3 ± 1.1 kg/m2) and 27 age and gender matched lean subjects (BMI 22.9 ± 0.43 kg/m2). Fecal calprotectin, SCFAs, plasma cytokines, and hsCRP were assessed as inflammatory and metabolic markers. Comparisons: (a) morbidly obese subjects vs. controls and (b) 2 and 6 months postsleeve vs. presleeve gastrectomy (n = 14). In another group of 10 morbidly obese and 11 matched lean subjects colonic and ileal biopsies were obtained in order to measure gene transcription of tight junction proteins. RESULTS: Gastroduodenal permeability (urinary sucrose recovery) was significantly increased in obese vs. lean controls (p < 0.05). Small intestinal and colonic permeability (urinary recovery of lactulose/L-rhamnose and sucralose/erythritol, respectively) in obese subjects were not significantly different from controls. Morbidly obese subjects had a proinflammatory systemic and intestinal profile compared with lean subjects. After sleeve gastrectomy BMI decreased significantly (p < 0.001). Postsleeve gastroduodenal permeability normalized to values that do not differ from lean controls. CONCLUSIONS: Gastroduodenal permeability, but not small intestinal or colonic permeability, is significantly increased in morbidly obese patients. After sleeve gastrectomy, gastroduodenal permeability normalized to values in the range of lean controls. Thus, the proximal gastrointestinal barrier is compromised in morbid obesity and is associated with a proinflammatory intestinal and systemic profile.
BACKGROUND:Obesity has been associated with impaired intestinal barrier function. It is not known whether bariatric surgery leads to changes in intestinal barrier function. We hypothesized that obesity is associated with disturbances in gastrointestinal barrier function, and that after bariatric surgery barrier function will improve. METHODS: Prospective single center study in which we assessed segmental gut permeability by urinary recovery of a multisugar drink in 27 morbidly obese (BMI 43.3 ± 1.1 kg/m2) and 27 age and gender matched lean subjects (BMI 22.9 ± 0.43 kg/m2). Fecal calprotectin, SCFAs, plasma cytokines, and hsCRP were assessed as inflammatory and metabolic markers. Comparisons: (a) morbidly obese subjects vs. controls and (b) 2 and 6 months postsleeve vs. presleeve gastrectomy (n = 14). In another group of 10 morbidly obese and 11 matched lean subjects colonic and ileal biopsies were obtained in order to measure gene transcription of tight junction proteins. RESULTS: Gastroduodenal permeability (urinary sucrose recovery) was significantly increased in obese vs. lean controls (p < 0.05). Small intestinal and colonic permeability (urinary recovery of lactulose/L-rhamnose and sucralose/erythritol, respectively) in obese subjects were not significantly different from controls. Morbidly obese subjects had a proinflammatory systemic and intestinal profile compared with lean subjects. After sleeve gastrectomy BMI decreased significantly (p < 0.001). Postsleeve gastroduodenal permeability normalized to values that do not differ from lean controls. CONCLUSIONS: Gastroduodenal permeability, but not small intestinal or colonic permeability, is significantly increased in morbidly obesepatients. After sleeve gastrectomy, gastroduodenal permeability normalized to values in the range of lean controls. Thus, the proximal gastrointestinal barrier is compromised in morbid obesity and is associated with a proinflammatory intestinal and systemic profile.
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