Relationships of gastric emptying, appetite and gastrointestinal hormones following consumption of solid and liquid food in people who have had gastric bypass surgery for treatment of obesity
Effects of Roux-en-Y gastric bypass on gastric emptying and small intestinal transit of solid and liquid meal components – relationship to effects on appetite and gastrointestinal hormones
The University of Adelaide
15 participants
May 23, 2022
Interventional
Conditions
Summary
Following Roux-en-Y gastric bypass, a type of surgery to induce weight loss in individuals who are obese, the size of the stomach is considerably reduced and food passes through to the small intestines faster. When food passes through the small intestines, various ‘hormones’ that are thought to assist with weight loss are released and enter the bloodstream. While this seems to be a useful effect, a proportion of patients can experience complications such as having an abnormally low blood sugar level (hypoglycaemia) or low blood pressure after eating. We think this may happen due to these patients producing more of these ‘hormones’ than others. This study will evaluate the movement of solid and liquid food that have been eaten and how it affects the amount of ‘hormones’ produced. Given the smaller size of the stomach, liquids could ‘wash down’ the solid food and increase the amount of ‘hormones’ produced. Learning about how the passage of solid and liquid food through the small intestine changes the amount of ‘hormones’ produced will lead to a better understanding these complications and help us develop new and more effective treatment. This information may also help us improve the dietary advice provided to patients who have had this surgery.
Eligibility
Inclusion Criteria1
- Male and/or female participants aged 18 – 65 years, who have had Roux-en-Y gastric bypass surgery at least 6 months previously
Exclusion Criteria19
- Use of any medication that may influence gastrointestinal motor function that cannot be withheld for the study (e.g. GLP-1 receptor agonists, acarbose, opiates, anticholinergics, levodopa, clonidine, nitrates, phosphodiesterase type 5 inhibitors, sumatriptan, metoclopramide, domperidone, prucalopride, or erythromycin)
- Uncontrolled diabetes (HbA1c >7.5%)
- Evidence of drug abuse, consumption of more than 20 g alcohol or 10 cigarettes on a daily basis
- History of chronic gastrointestinal disease (inflammatory bowel disease, coeliac disease) or prior gastrointestinal surgery (other than other than bariatric surgery, uncomplicated appendicectomy or cholecystectomy)
- History of epilepsy
- History of severe respiratory, cardiovascular, hepatic and/or renal disease (severe in that the social or physical manifestation of the disease, or living with the condition, impact negatively and significantly on the individuals’ ability to lead a normal day to day life).
- Impaired renal (as assessed by calculated creatinine clearance < 90 mL/min, iron status, or liver function tests outside the following ranges:
- Alanine aminotransferase (ALT) >3x ULN
- Aspartate transaminase (AST) >3x ULN
- Alkaline phosphatase (ALP) >3x ULN
- Bilirubin >24 mmol/L
- Ferritin <15 ng/mL (Females), <30 ng/mL (Males)
- Haemoglobin <115 g/L (Females), <13 g/L (Males)
- Donation of blood within the previous 3 months
- Participation in any other research studies within the previous 3 months that requires blood sampling
- Exposure to ionising radiation >3mSv for research purposes within the past 12 months
- Vegetarian
- Inability to give informed consent
- Female participants who are pregnant or planning for pregnancy, or are lactating
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Interventions
Participants will be given a solid meal consisting of 50g beef patty (584 kJ) that has been radiolabelled with 20 Mbq of technetium-99m sulphur colloid. The meal will be administered by a trained medical professional and will be consumed over 5 minutes at the research facility. The consumption of the solid meal will be supervised by the medical professional. Following this, gastric emptying data will be acquired in 1-min frames for the first 60 minutes, followed by 3-minute frames until t = 240 minutes. A region-of-interest that corresponds to the gastric pouch will be drawn to derive emptying curves and after 30 minutes, participants will be given a drink consisting of 150ml glucose (50g of glucose, 840kJ) containing 7 MBq gallium-67 EDTA which will include 3g 3-O-methylglucose (3-OMG, Sigma Aldrich USA). The time taken for 50% of the solid food to be emptied from the gastric pouch will be measured. All components are expected to be completed within a single 6 hour session. This intervention will be applied once only per participant.
Locations(2)
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ACTRN12621001599864