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Changes in Bile Acid Profile After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Metabolic Profile and Fatty Liver Disease

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Abstract

Background

Bile acids (BA) modulate lipid and glucose metabolism in a feedback loop through production of fibroblast growth factor (FGF) 19 in the terminal ileum. Changes in BA after bariatric surgery may lead to improvements in the metabolic syndrome, including fatty liver disease. This study investigated the relationship between BA and metabolic and inflammatory profiles after laparoscopic sleeve gastrectomy (LSG).

Methods

Patients undergoing LSG had fasting blood samples taken pre-operatively and 6 months post-surgery. Liver injury was measured using cytokeratin (CK) 18 fragments. BA were measured using liquid chromatography tandem-mass spectrometry. FGF-19 was measured using enzyme-linked immunosorbent assay.

Results

The study included 18 patients (12 females), with mean age 46.3 years (SEM ± 2.9) and BMI 60.1 kg/m2 (±2.6). After 6 months, patients lost 39.8 kg (±3.1; p < 0.001). Fourteen patients (78 %) had steatosis. FGF-19 increased from median 128.1 (IQR 89.4–210.1) to 177.1 (121.8–288.9, p = 0.045) at 6 months. Although total BA did not change, primary glycine- and taurine-conjugated BA, cholic acid decreased, and secondary BA, glycine-conjugated urodeoxycholic acid increased over the study period. These changes are associated with reduction in insulin resistance, pro-inflammatory cytokines and CK-18 levels.

Conclusions

The profile of individual BA is altered after LSG. These changes occur in the presence of reductions in inflammatory cytokines and markers of liver injury. This study supports evidence from recent animal models that LSG may have an effect on fatty liver through changes in BA metabolism.

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Author information

Authors and Affiliations

  1. Department of Minimally Invasive, Bariatric and Laparoscopic HPB Surgery, King’s College Hospital, London, SE5 9RS, UK

    Ajay P. Belgaumkar, Kirstin A. Carswell & Ameet G. Patel

  2. Department of Biochemistry, King’s College Hospital, London, UK

    Royce P. Vincent & Jamie Alaghband-Zadeh

  3. Institute of Liver Studies, King’s College Hospital, London, UK

    Robin D. Hughes & Ragai R. Mitry

  4. Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Ireland

    Carel W. le Roux

Authors
  1. Ajay P. Belgaumkar
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  2. Royce P. Vincent
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  3. Kirstin A. Carswell
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  7. Carel W. le Roux
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  8. Ameet G. Patel
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Correspondence to Ajay P. Belgaumkar.

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Compliance with Ethical Standards

Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no competing interests.

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Belgaumkar, A.P., Vincent, R.P., Carswell, K.A. et al. Changes in Bile Acid Profile After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Metabolic Profile and Fatty Liver Disease. OBES SURG 26, 1195–1202 (2016). https://doi.org/10.1007/s11695-015-1878-1

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