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16 October 2007
Nutrient Danger From Gastric-Bypass Surgery

Researchers at Washington Hospital Center have said that a potentially serious condition can emerge after gastric bypass surgery known as small intestinal bacterial overgrowth that has an impact on absorption of vitamins, minerals and micronutrients such as calcium and zinc.

Speaking at the 72nd Annual Scientific Meeting of the American College of Gastroenterology, Dr. Frederick Finelli and Dr. Timothy Koch suggested that it was a serious issue with widespread implications as approximately 150,000 patients this year will have gastric bypass surgery, and there exists wide variation in surgical techniques. According to Dr. Koch, "patients may develop bacterial overgrowth that interferes with their ability to absorb nutrients, even if they are taking supplements as directed after surgery. Only a gastroenterologist can evaluate these potentially serious small intestinal disorders."

The researchers believe that by altering the gut ecology, gastric bypass surgery can induce calcium deficiency. Surgical changes to the stomach to create the "gastric pouch" in the Roux-en-Y procedure impact the number of acid producing cells in the stomach lining. Furthermore, many gastric bypass patients are given acid suppressing drugs after their surgery. Researchers suspect that the reduction in acid (known as achlorhydria) contributes to the overgrowth of bacteria in the small intestine. According to Dr. Koch, competition between bacteria and the human host for ingested nutrients leads to malabsorption and micronutrient deficiency.

In the Roux-en-Y procedure, surgeons make the stomach smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. Dr. Koch explained that the wide variation in surgical techniques for gastric bypass means that patients should be aware of the risk of problems absorbing nutrients, and should consult with a gastrointestinal specialist before undergoing any bypass procedure.

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Source: American College of Gastroenterology

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