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Bariatric Surgery

Intestinal barrier function in morbid obesity: results of a prospective study on the effect of sleeve gastrectomy

International Journal of Obesity volume 44, pages 368–376 (2020)Cite this article

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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.

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Acknowledgements

We would like to thank Anton van der Stokker, analyst at the laboratory of the Catharina hospital in Eindhoven, for analyzing hsCRP and for collecting and preserving all specimens before analysis. We would like to thank the department of Surgery in Maastricht for analyzing urine specimens.

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Authors and Affiliations

  1. Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands

    Jennifer Wilbrink, Zlatan Mujagic, Mark van Avesaat, Kirsten Pijls, Tim Klaassen, Ellen Wilms, Freddy Troost & Ad Masclee

  2. Department of Gastroenterology-Hepatology, Catharina Hospital, Eindhoven, The Netherlands

    Jennifer Wilbrink, Nienke Bernards & Arnold Stronkhorst

  3. Department of Gastroenterology-Hepatology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The Netherlands

    Jennifer Wilbrink

  4. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands

    Jennifer Wilbrink, Zlatan Mujagic, Mark van Avesaat, Kirsten Pijls, Tim Klaassen, Ellen Wilms, Freddy Troost & Ad Masclee

  5. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Hans van Eijk

  6. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Simon Nienhuijs

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Correspondence to Jennifer Wilbrink.

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Wilbrink, J., Bernards, N., Mujagic, Z. et al. Intestinal barrier function in morbid obesity: results of a prospective study on the effect of sleeve gastrectomy. Int J Obes 44, 368–376 (2020). https://doi.org/10.1038/s41366-019-0492-z

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