Bile acids and gut peptide secretion after bariatric surgery: a 1-year prospective randomized pilot trial. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. Intestinal adaptation after ileal interposition surgery increases bile acid recycling and protects against obesity-related comorbidities. Bile acids synthesis decreases after laparoscopic sleeve gastrectomy. Increase of Osteopontin Plasma Concentrations After Bariatric Surgery Independent from Inflammation and Insulin Resistance Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Gut microbiota specific signatures are related to the successful rate of bariatric surgery. Road Running After Gastric Bypass for Morbid Obesity: Rationale and Results of a New Protocol The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Bile acid profiles over 5 years after gastric bypass and duodenal switch: results from a randomized clinical trial. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study—A Two-Year Randomized Controlled Clinical Trial Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Outcomes of bariatric surgery in patients with body mass index <35 kg/m2. Increased glycine-amidated hyocholic acid correlates to improved early weight loss after sleeve gastrectomy Changes in Gut Microbiota Composition after Bariatric Surgery: a New Balance to Decode Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Weight loss is a major contributor to improved sexual function after bariatric surgery Fat malabsorption and increased intestinal oxalate absorption are common after Roux-en-Y gastric bypass surgery. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Inhibition of C-Reactive Protein in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy Bariatric surgery in patients with liver cirrhosis.
OBJECTIVE Increased delivery of bile acid salts ( BA ) to distal L-cells and altered TGR5 receptor activation may contribute to the early and substantial increases in gut peptide secretion seen after bariatric surgery . To further eluci date a potential role of BA in the secretion of GLP-1 and PYY , we analyzed plasma BA concentrations in 14 morbidly obese patients undergoing gastric bypass or sleeve gastrectomy in a prospect i ve , r and omized 1-year trial . DESIGN AND METHODS Patients  received a st and ard test meal and blood was collected before and after eating , prior to , and 1 week , 3 months , and 12 months after surgery . RESULTS Pre-surgery , basal BA concentrations were significantly lower in bariatric patients than in healthy controls . One year post-surgery , bariatric patients expressed variably increased BA concentrations ( gastric bypass patients ∼2 fold increase , P ≤ 0.05 ) . However , whereas in both patient groups , marked increases in GLP-1 and PYY and improved glycemic control was seen already 1 week and 3 months post-surgery , changes in plasma BA followed a different pattern : basal and postpr and ial plasma BA concentrations increased much slower , more progressively with significant increases only 1-year post-surgery . CONCLUSIONS Based on these findings , BA do not appear to be key mediators of the early increase in GLP-1 and PYY response in post-bariatric patients CONTEXT It has been hypothesized that increased plasma bile acids ( BAs ) contribute to metabolic improvements after Roux-en-Y gastric bypass ( RYGB ) surgery by the G protein-coupled receptor TGR5-mediated effects on glucagon-like peptide-1 secretion and thyroid hormones . OBJECTIVE The objective of this study was to evaluate the importance of bariatric surgery-induced alterations in BA physiology on factors that regulate glucose homeostasis ( insulin secretion and sensitivity ) and energy metabolism ( resting energy expenditure and thyroid hormone axis ) . DESIGN , PARTICIPANTS , INTERVENTION , AND MAIN OUTCOME MEASURE : Eighteen extremely obese subjects were studied before and after 20 % weight loss , induced by either laparoscopic adjustable gastric b and ing ( LAGB ) ( n = 10 ) or RYGB surgery ( n = 8) . RESULTS Plasma BAs more than doubled after RYGB [ fasting : 1.08 ( 0.26 - 1.42 ) to 2.28 ( 1.59 - 3.28 ) μmol/L , P = .03 ; postpr and ial : 2.46 ± 1.59 to 6.00 ± 2.75 μmol/L , P = .01 ] but were either lower or did not change after LAGB [ fasting : 1.80 ( 1.49 - 2.19 ) to 0.92 ( 0.73 - 1.15 ) μmol/L , P = .02 ; postpr and ial : 3.71 ± 2.61 to 2.82 ± 1.75 μmol/L , P = .14 ] . Skeletal muscle expression of TGR5 targets , Kir6.2 and cyclooxygenase IV , increased after RYGB but not LAGB . Surgery-induced changes in BAs were associated with increased peak postpr and ial plasma glucagon-like peptide-1 ( r(2 ) = 0.509 , P = .001 ) and decreased serum TSH ( r(2 ) = 0.562 , P < .001 ) but did not correlate with the change in insulin response to a meal ( r(2 ) = 0.013 , P = .658 ) , insulin sensitivity ( assessed as insulin stimulated glucose disposal during a hyperinsulinemic-euglycemic clamp procedure ) ( r(2 ) = 0.001 , P = .995 ) , or resting energy expenditure ( r(2 ) = 0.004 , P = .807 ) . CONCLUSIONS Compared with LAGB , RYGB increases circulating BAs and TGR5 signaling , but this increase in BAs is not a significant predictor of changes in glucose homeostasis or energy metabolism Surgical interposition of distal ileum into the proximal jejunum is a bariatric procedure that improves the metabolic syndrome . Changes in intestinal and hepatic physiology after ileal interposition ( transposition ) surgery ( IIS )  are not well understood . Our aim was to eluci date the adaptation of the interposed ileum , which we hypothesized , would lead to early bile acid reabsorption in the interposed ileum , thus short circuiting enterohepatic bile acid recycling to more proximal bowel segments . Rats with diet-induced obesity were r and omized to IIS  , with 10 cm of ileum repositioned distal to the duodenum , or sham surgery . A subgroup of sham rats was pair-fed to IIS rats . Physiological parameters were measured until 6 wk postsurgery . IIS rats ate less and lost more weight for the first 2 wk postsurgery . At study completion , body weights were not different , but IIS rats had reversed components of the metabolic syndrome . The interposed ileal segment adapted to a more jejunum-like villi length , mucosal surface area , and GATA4/ILBP mRNA . The interposed segment retained capacity for bile acid reabsorption and anorectic hormone secretion with the presence of ASBT and glucagon-like-peptide-1-positive cells in the villi . IIS rats had reduced primary bile acid levels in the proximal intestinal tract and higher primary bile acid levels in the serum , suggesting an early and efficient reabsorption of primary bile acids . IIS rats also had increased taurine and glycine-conjugated serum bile acids and reduced fecal bile acid loss . There was decreased hepatic Cyp27A1 mRNA with no changes in hepatic FXR , SHP , or NTCP expression . IIS protects against the metabolic syndrome through short-circuiting enterohepatic bile acid recycling . There is early reabsorption of primary bile acids despite selective " jejunization " of the interposed ileal segment . Changes in serum bile acids or bile acid enterohepatic recycling may mediate the metabolic benefits seen after bariatric surgery BACKGROUND Bariatric surgery is the most effective treatment alternative in morbid obesity . The mechanisms contributing to these benefits remain poorly understood . Bile acids ( BAs ) are mediators of different regulatory functions in glucose and cholesterol homeostasis and energy expenditure . Recent evidence suggests that BAs are critically important for the beneficial effects of sleeve gastrectomy ( SG ) . OBJECTIVES The aim of this study was to evaluate the effect of SG on BA synthesis . SETTING University Hospital . Santiago , Chile . METHODS Obese patients were evaluated before and after SG ( 1 , 3 , 6 , and 12 months ) . BA synthesis was evaluated through the serum marker , 7 α-hydroxy-4-cholesten-3-one ( C4 ) . Primary and secondary BA and C4 were determined by high performance liquid chromatography coupled with t and em mass spectrometry detection ( HPLC-MS/MS ) . RESULTS From June 2013 to January 2014 , 19 patients ( age 37.6±7.8 years ; BMI 35.8±3.5 kg/m(2 ) ; 79 % female ) were included in this study . Mean weight loss at 1 , 3 , 6 , and 12 months was 11.3 , 17.5 , 23.6 , and 25.4 kg , respectively , equivalent to 11.8 , 18.6 , 24.8 , and 26.9 of total body water percentage ( % TBW ) ( P<.0001 ) , respectively and 43.2 , 68.2 , 91 , and 98.8 of percentage of excess weight loss ( % EWL ) , respectively ( P<.001 ) . Serum C4 levels at baseline , 1 , 3 , 6 , and 12 months were 23.4±21.1 , 4.9±8.2 , 8.7±12.1 , 13.8±12.9 , and 18.8±16.8 ng/mL ( P<.0001 ) , respectively . Fibroblast growth factor 19 ( FGF19 ) levels at baseline , 1 , 3 , 6 , and 12 months were 71±33.3 , 130.5±66.2 , 117.8±57.2 , 134.6±91.7 , and 124.3±85.9 pg/mL ( P = .019 ) , respectively . CONCLUSION Serum levels of C4 decrease after SG , indicating a reduction in the synthesis of BA . FGF19 may play a role in decreasing BA synthesis . Further studies are necessary to characterize the effect of bariatric surgery on BA homeostasis Background  Osteopontin ( OPN  ) is a multifunctional matrix glycoprotein associated with bone metabolism and has been linked to chronic inflammation , insulin resistance , and atherosclerosis . Diet-induced weight loss decreases elevated OPN concentrations in obese patients . The aim of the current study was to investigate the role of OPN after bariatric surgery , where not only improvements of chronic inflammation , insulin resistance and comorbidities , but also malabsorption and altered bone metabolism have been reported . Methods OPN plasma concentrations  were determined in 31 morbidly obese patients ( 5 men , 26 women , BMI 46.2 ± 7.1 kg/m2 , age 41 ± 11 years ; mean ± SD ) before and 18 months after bariatric surgery , together with parameters of bone metabolism and inflammation . Results OPN concentrations increased by + 20.3 ± 26.6 ng/ml ( mean ± SD , p < 0.01 ) , concomitant to a weight loss of −38 ± 22 kg , and a decrease in BMI by −13.1 ± 7.7 kg/m2 ( both p < 0.01 ) . HOMA-index improved from 5.2 ± 3.4 to 1.5 ± 1.0 ( p < 0.01 ) . Calcium concentrations slightly decreased , and phosphate increased ( −0.06 ± 0.13 mmol/l and + 0.08 ± 0.16 mmol/l , respectively ; both p < 0.05 ) , while 25-OH-VitaminD3 remained unchanged and PTH tended to increase ( + 5.1 ± 14.0 pg/ml , p = 0.054 ) . Monocyte chemoattractant protein 1 and interleukin 18 were significantly decreased and associated with HOMA both before and after bariatric surgery . ΔOPN was correlated with ΔPTH , but not with other parameters .  Conclusions OPN plasma concentrations increased concomitant to weight loss after bariatric surgery , which was independent from an improvement of insulin sensitivity and a decrease of inflammatory markers . Further studies are needed to differentiate whether these changes in bone metabolism after bariatric surgery are secondary to calcium deficiency or an adaptation to weight loss Summary Bariatric surgery is currently the most effective procedure for the treatment of obesity . Given the role of the gut microbiota in regulating host metabolism and adiposity , we investigated the long-term effects of bariatric surgery on the microbiome of patients r and omized to Roux-en-Y gastric bypass or vertical b and ed gastroplasty and matched for weight and fat mass loss . The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and result ed in altered levels of fecal and circulating metabolites compared with obese controls . By colonizing germ-free mice with stools from the patients , we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice . These mice also had a lower respiratory quotient , indicating decreased utilization of carbohydrates as fuel . Our results suggest that the gut microbiota may play a direct role in the reduction of adiposity observed after bariatric surgery BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery BACKGROUND We investigated the biochemical and inflammatory parameters as well as biomarkers of oxidative stress in morbidly obese patients before and after bariatric surgery and clinical treatment .  METHODS This study was conducted using 60 individuals ( 10 men and 50 women ) distributed into 3 groups :  the control group , 20 non-diabetic obese patients given clinical treatment , the bariatric group , 20 non-diabetic obese patients given a Roux-en-Y bypass gastroplasty , and the bariatric diabetic group , 20 diabetic obese patients given a Roux-en-Y bypass gastroplasty .  Measurements were made before and 1 , 3 , 6 , and 12months after surgery and clinical treatment . RESULTS We showed a significant decrease in body weight , body mass index ( BMI ) and waist circumference , accompanied by a decrease in the lipid profile and glucose and glycated hemoglobin concentrations in the groups that received bariatric surgery . The concentrations of lipid peroxidation , carbonyl protein and NPSH , as well as superoxide dismutase ( SOD ) and catalase ( CAT ) activity , significantly decreased in both groups after surgery . The concentrations of inteleukin-6 , inteleukin-1 , TNF-α and resistin were also significantly lower , while adiponectin concentrations significantly increased 12months after bariatric surgery . No significant alterations were observed in the biochemical , inflammatory or oxidative parameters of the control group . CONCLUSIONS Our findings demonstrate a decrease in body mass and a subsequent improvement in biochemical , metabolic and anthropometric parameters in patients given bariatric surgery .  This may contribute to the reduction of oxidative damage in these patients and consequently a reduction in the risk of the development and progression of multiple co-morbidities associated with obesity Bariatric  surgery ( BS ) success rates vary in the long-time . A better underst and ing of weight-loss response may help improve the outcomes of BS . Gut microbiome could be implicated in the successful rate of BS . The aim of the study is to analyze the role of gut microbiome in the successful rate of BS . This is a cross-sectional study of a prospect i ve cohort of 24 patients who underwent gastric bypass . Patients were classified based on excess weight loss ( EWL ) as : Success ( EWL50 % at nadir weight and throughout follow-up ) , Primary Failure ( EWL<50 % at nadir weight and thereafter ) , and Weight Regain ( EWL>50 % at nadir weight , but < 50 % at last follow-up visit ) . Gut microbiome analysis was assessed by High Throughput Sequencing . Cholesterol metabolism was shown as the most affected parameter among groups . Studied groups registered minor changes between their gut microbiome abundances , with Butyrivibrio , Lachnospira and Sarcina among them . However , Success group shared a more diverse core microbiome than the other groups . We showed evidence of a possible role of gut microbiome in the cholesterol metabolism , possibly through bile acids , relative to the success or failure of BS outcomes . Acinetobacter and Serratia , from Primary Failure core microbiome , could have implication s in its successful rate . Sarcina abundance was presented as the best genera related to the body mass index ( BMI ) post-surgery . Gut microbiota could mediate , at least partially , the success rate of BS through their interaction with the bile acids milieu . Further studies are necessary to vali date this probe of concept Background In recent years , the p and emic explosion of obesity has led to the definition of a pre-eminent therapeutic role for bariatric surgery , confining physical activity to a success parameter of surgery rather than a primary prevention measure . The aim of this study is to evaluate the role for aerobic physical activity ( road running ) in strengthening the metabolic and psychosocial effects of bariatric surgery . Methods Ten patients who underwent gastric bypass for morbid obesity were su bmi tted to an intensive program of road running training , aim ed at completing a 10.5-km competition in September 2013 . Inclusion criteria included age ( < 50 ) , BMI ( < 35 ) , suitability for sport activity , and good compliance . A cohort of 10 patients excluded for logistical issues were enrolled as a  control group . During the training period , patients were su bmi tted to biometrical , sport performance , cardiopulmonary , metabolic , and psychiatric evaluations . Results Protocol adherence was 70 % ; no physical injury was registered among participants . More than weight loss ( BMI 29.3 to 27.1 ) , the runners experienced a redistribution of body mass with significant differences in fat percentage and waist/hip ratio . Participants had a significant running performance improvement and , differently from the controls , a significant amelioration of echocardiographic and cardiopulmonary parameters , predicting a reduction in cardiovascular risk . Psychiatric evaluation underlined a tendency to a reduction in anxiety , depression , and general psychopathology symptoms . Conclusions Road running seems to have an important supporting role in boosting bariatric surgery results . The utilization of monitored and regulated training programs represents a fundamental prerequisite to achieving satisfactory results and patient compliance BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients BACKGROUND Bile acids have been proposed as key mediators of the metabolic effects after bariatric surgery . Currently no reports on bile acid profiles after duodenal switch exist , and long-term data after gastric bypass are lacking . OBJECTIVE To investigate bile acid profiles up to 5 years after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch and to explore the relationship among bile acids and weight loss , lipid profile , and glucose metabolism . SETTING S Two Sc and inavian University Hospitals . METHODS We present data from a r and omized clinical trial of 60 patients with body mass index 50 - 60 kg/m2 operated with gastric bypass or duodenal switch .  Repeated measurements of total and individual bile acids from fasting serum during 5 years after surgery were performed . RESULTS Mean concentrations of total bile acids increased from 2.3 µmol/L ( 95 % confidence interval [ CI ] , -.1 to 4.7 ) at baseline to 5.9 µmol/L ( 3.5 - 8.3 ) 5 years after gastric bypass and from 1.0 µmol/L ( 95 % CI , -1.4 to 3.5 ) to 9.5 µmol/L ( 95 % CI , 7.1 - 11.9 ) after duodenal switch ; mean between-group difference was -4.8 µmol/L ( 95 % CI , -9.3 to -.3 ) , P = .036 . Mean concentrations of primary bile acids increased more after duodenal switch , whereas secondary bile acids increased proportionally across the groups . Higher levels of total bile acids at 5 years were associated with lower body mass index , greater weight loss , and lower total cholesterol . CONCLUSIONS Total bile acid concentrations increased substantially over 5 years after both gastric bypass and duodenal switch , with greater increases in total and primary bile acids after duodenal switch . ( Surg Obes Relat Dis 2017;0:000 - 000 . ) © 2017 American Society for Metabolic and Bariatric Surgery . All rights reserved Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity Background Bile acids ( BAs ) are post-pr and ial hormones that play an important role in glucose and lipid homeostasis as well as energy expenditure . Total and glycine-ami date d BAs increase after sleeve gastrectomy ( SG ) and correlate to improved metabolic disease . No specific bile acid subtype has been shown conclusively to mediate the weight loss effect . Therefore , the objective of this study was to prospect ively evaluate the comprehensive changes in meal-stimulated BAs after SG and determine if a specific change in the BA profile correlates to the early weight loss response . Methods Patients were prospect ively enrolled at the University of Nebraska Medical Center who were undergoing a SG for treatment of morbid obesity . Primary and secondary plasma bile acids and their ami date d ( glycine , G- , or taurine , T- ) subtypes were measured at fasting , 30 and 60 min after a liquid meal performed pre-op , and at 6 and 12 weeks post-op . Area under the curve ( AUC ) was calculated for the hour meal test for each bile acid subtype . BAs that were significantly increased post-op were correlated to body mass index ( BMI ) loss . Results Total BA AUC was significantly increased at 6 ( p < 0.01 ) and 12 weeks post-op ( p < 0.01 ) compared to pre-operative values . The increase in total BA AUC was due to a statistically significant increase in G-BAs . Nine different BA AUC subtypes were significantly increased at both 6 and 12 weeks post-op . Increased total and G-chenodeoxycholic acid AUC was significantly correlated to the 6 week BMI loss ( p = 0.03 ) . Increased G-hyocholic acid was significantly correlated to increased weight loss at both 6 ( p = 0.05 ) and 12 weeks ( p = 0.006 ) . Conclusions SG induced an early and persistent post-pr and ial surge in multiple bile acid subtypes . Increased G-hyocholic consistently correlated with greater early BMI loss . This study provides evidence for a role of BAs in the surgical weight loss response after SG Recently , the link between obesity and gut microbiota has become a focus for research . This study shed some light on the modification of postoperative gut microbial composition after  bariatric surgery .  A prospect i ve longitudinal study on healthy lean subjects and patients who underwent bariatric surgery ( Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy )  was carried out . Anthropometric and metabolic data , smoking , food preferences data , and stool sample s were collected from lean subjects and from obese patients before and 3 and 6 months after surgery ( T0 , T3 , and T6 , respectively ) . We collected stool sample s from 25 obese patients before surgery and 3 and 6 months thereafter and from 25 normal weight patients . After Roux-en-Y gastric bypass , Yokenella regensburgei ( p < 0.05 ) , Fusobacterium varium ( p < 0.05 ) , Veillonella dispar/atypica ( p < 0.05 ) , and Streptococcus australis/gordonii ( p < 0.05 ) were transiently identified in the gut at T3 . Roux-en-Y gastric bypass patients had a permanent increase in Akkermansia muciniphila ( p < 0.05 ) , which is associated with healthy metabolism , both at T3 and T6 . There were no significant changes in gut microbiota in laparoscopic sleeve gastrectomy patients . In our study , Roux-en-Y gastric bypass induced major microbial differences and greater weight loss compared with laparoscopic sleeve gastrectomy . Analyzing the microbiota composition , a proliferation of potential pathogens and the onset of beneficial bacteria was observed . The effects of these bacteria on human health are still far from clear . Underst and ing the mechanisms of action of these bacteria could be the keystone in developing new therapeutic strategies for obesity BACKGROUND The surgical treatment of diabetes had witnessed progressive development and success since the first case of pancreatic transplantation . Although this was a great step , wide clinical application was limited by several factors . Bariatric surgery such as gastric bypass is emerging as a promising option in obese patients with type 2 diabetes . The aim of this article is to explore the current application of gastric bypass in patients with type 2 diabetes and the theoretical bases of gastric bypass as a treatment option for type 1 diabetes . METHODS We performed a MEDLINE search for articles published from August 1955 to December 2008 using the words " surgical treatment of diabetes , " " etiology of diabetes " and " gastric bypass . " RESULTS We identified 3215 studies and selected 72 relevant papers for review . Surgical treatment of diabetes is evolving from complex pancreatic and islets transplantation surgery for type 1 diabetes with critical postoperative outcome and follow-up to a metabolic surgery , including gastric bypass . Gastric bypass ( no immune suppression or graft rejection ) has proven to be highly effective treatment for obese patients and nonobese animals with type 2 diabetes . There are certain shared criteria between types 1 and 2 diabetes , making a selected spectrum of the disease a potential target for metabolic surgery to improve or cure diabetes . CONCLUSION Roux-en-Y gastric bypass is a promising option for lifelong treatment of type 2 diabetes . It has the potential to improve or cure a selected spectrum of type 1 diabetes when performed early in the disease . Further animal model studies or r and omized controlled trials are needed to support our conclusion Background The relative contribution of anthropometric , hormonal , and metabolic changes after  bariatric surgery ( BS ) on sexual function ( SF ) in severely obese subjects is not well established . Methods Prospect i ve observational case series study of 39 men undergoing BS .  SF was assessed by means of the international index of erectile function ( IIEF ) before and at 1 year after surgery . At the same time points , anthropometric ( body mass index , waist circumference ) , hormonal ( testosterone , sex hormone binding globulin , estradiol , gonadotropins , inhibin B , prolactin , leptin ) , and metabolic parameters ( insulin sensitivity , C-reactive protein , lipid profile , hemoglobin A1c , presence of hypertension or sleep apnea ) were assessed . Results BS was associated with marked weight loss ( 77.18 % excess weight loss ) , improved IIEF score ( baseline : 54.85 ± 16.59 , 1 year : 61.21 ± 14.10 ; p < 0.01 ) , gonadal function ( testosterone : baseline 256.36 ± 120.98 , 1 year : 508.01 ± 161.90 ; p < 0.001 ) , and improved metabolic profile . However , on multivariate regression analysis whereas changes in body mass index ( beta : −0.677 , p = 0.001 ) , and baseline IIEF score ( beta : −0.397 , p = 0.023 ) , were independent predictors of the changes in the IIEF score at 1 year after surgery , changes in hormonal and metabolic factors were not . Variables in the model accounted for 66 % of the postsurgical variation in the IIEF score . Similar results were found when the different IIEF-sexual domains were evaluated , except for intercourse satisfaction for which no independent predictor was identified . Conclusions Weight loss ’s beneficial effects on SF occurring after BS are beyond the parallel improvement in gonadal and metabolic profiles BACKGROUND Hyperoxaluria and increased calcium oxalate stone formation occur after Roux-en-Y gastric bypass ( RYGB ) surgery for morbid obesity . The etiology of this hyperoxaluria is unknown . We hypothesized that after bariatric surgery , intestinal hyperabsorption of oxalate contributes to increases in plasma oxalate and urinary calcium oxalate supersaturation . METHODS We prospect ively examined oxalate metabolism in 11 morbidly obese subjects before and 6 and 12 months after RYGB ( n = 9 ) and biliopancreatic diversion-duodenal switch ( BPD-DS ) ( n = 2 ) . We measured 24-hour urinary supersaturations for calcium oxalate , apatite , brushite , uric acid , and sodium urate ; fasting plasma oxalate ; 72-hour fecal fat ; and increases in urine oxalate following an oral oxalate load . RESULTS Six and 12 months after RYGB , plasma oxalate and urine calcium oxalate supersaturation increased significantly compared with similar measurements obtained before surgery ( all P ≤ .02 ) . Fecal fat excretion at 6 and 12 months was increased ( P = .026 and .055 , 0 vs 6 and 12 months ) . An increase in urine oxalate excretion after an oral dose of oxalate was observed at 6 and 12 months ( all P ≤ .02 ) . Therefore , after bariatric surgery , increases in fecal fat excretion , urinary oxalate excretion after an oral oxalate load , plasma oxalate , and urinary calcium oxalate supersaturation values were observed . CONCLUSION Enteric hyperoxaluria is often present in patients after the operations  of RYGB and BPD-DS  that utilize an element of intestinal malabsorption as a mechanism for weight loss Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment Background Obesity is considered a low- grade chronic inflammatory condition as reflected by increased C-reactive protein ( CRP ) levels . Inflammation is emerging as a predictor of cardiovascular disease and it may be a precursor of the metabolic syndrome . Bariatric surgery is commonly performed as a treatment for morbid obesity offering significant reductions in premature myocardial infa rct ion . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively new bariatric procedure that is currently used as a definitive procedure for weight loss . The aim of this study is to assess the impact of sleeve gastrectomy on CRP levels . Methods This study is part of an ongoing , prospect i ve , cohort study to evaluate LSG impact on iron indices . CRP levels were compared preoperatively and 6 months after surgery . Similarly , demographics including body mass index and excess weight were also compared at these same study points . Data were analyzed using Student paired t test and Pearson product moment correlation analysis . Results Twenty-nine morbidly obese patients were included . There was significant decrease in body mass index ( BMI ) between the preoperative and 6-month period ( 50.9 ± 13.2 and 35.1 ± 6.85 , respectively ; P < 0.001 ) . Also CRP levels were statistically significantly lower at 6 months after surgery ( preoperative 12.3 ± 7.53 mg/L and postoperative 5.6 ± 4.2 mg/L. P < 0.0001 ) . The significant weight loss as reflected by change in BMI was correlated with the difference between preoperative and postoperative CRP levels . Conclusions Massive weight loss in morbidly obese patients induced by LSG causes a significant decrease in CRP levels , which could reduce the risk of cardiovascular diseases in these patients BACKGROUND Data regarding the management of bariatric patients with cirrhosis are scarce , and there is no strong evidence that supports a specific approach for this group of patients . The aim of this study was to review our experience with cirrhotic patients undergoing bariatric surgery .  METHODS A prospect ively maintained data base was review ed to assess the outcomes of bariatric surgery for patients with known cirrhosis and for patients with cirrhosis discovered at surgery ( unknown cirrhosis ) . RESULTS From April 2004 to September 2011 , 23 patients ( 12 with known cirrhosis and 11 with unknown cirrhosis ) met inclusion criteria . There were 14 females and 9 males with a mean age of 51.5 ± 8.3 and a mean body mass index of 48.2 ± 8.6 kg/m2 . Child-Pugh classes were A ( n = 22 ) and B ( n = 1 ) . Patients had a high frequency of diabetes ( 83 % ) , dyslipidemia ( 61 % ) , and hypertension ( 83 % ) . Procedures performed were laparoscopic Roux-en-Y gastric bypass ( LRYGB ) ( n = 14 ) , laparoscopic sleeve gastrectomy ( LSG ) ( n = 8) , and laparoscopic adjustable gastric b and ing ( n = 1 ) . Two patients underwent LSG successfully after transjugular intrahepatic portosystemic shunt . Mean length of hospital stay was 4.3 ± 2.7 days . Complications developed in 8 patients . One patient died of unknown cause 9 months after surgery . No patients had liver decompensation after surgery . The patients lost 67.4 % ± 30.9 % of their excess weight at 12 months follow-up and 67.7 % ± 24.8 % at 37 months follow-up . CONCLUSION LRYGB and LSG can be performed without prohibitive complication rates in carefully selected patients with cirrhosis . In our experience , bariatric patients with cirrhosis achieved excellent weight loss and improvement in obesity-related co-morbidities
The findings support the effects of BAs on satiety , lipid and cholesterol metabolism , incretins and glucose homoeostasis , energy metabolism , gut microbiota and endoplasmic reticulum stress following bariatric surgery .
Many of these metabolic effects are modulated through the BA receptors FXR and TGR5 .
We also explore a possible link between BAs and carcinogenesis following bariatric surgery .
Conclusions : Overall there is good evidence to support the role of BAs in the metabolic effects of bariatric surgery through the above mechanisms .
BAs could serve as a novel therapeutic pharmacological target for the treatment of obesity and its associated co-morbidities
Background : Bariatric surgery is currently the most efficacious treatment for obesity and its associated metabolic co-morbidities , such as diabetes .
The metabolic improvements occur through both weight-dependent and weight-independent mechanisms .
Bile acids ( BAs ) have emerged as key signalling molecules that have a central role in modulating many of the physiological effects seen after bariatric surgery .
This systematic review assesses the evidence from both human and animal studies for the role of BAs in reducing the metabolic complications of obesity following bariatric surgery .