The Effect of Bariatric Surgery on Exocrine Pancreatic Function

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Nutritional Science

Background:

• Bariatric surgery (BS) can lead to nutrient maldigestion, malabsorption, and deficiencies.
• Assessing pancreatic function post-BS is crucial for patient management.

Purpose of the Study:

• To evaluate pancreatic exocrine function after different types of bariatric surgery using fecal elastase-1 (FE-1) assay.
• To investigate the efficacy of pancreatic enzyme replacement therapy (PERT) in patients with low FE-1 levels.

Main Methods:

• Sixty patients undergoing BS (SG, OAGB, SADS) and 20 controls were assessed one year post-surgery.
• Fecal elastase-1 (FE-1) levels, excess weight loss (EWL), BMI, GIQLI scores, and vitamin D levels were measured.
• PERT was administered to patients with the lowest FE-1 and GIQLI scores, followed by repeat measurements.

Main Results:

• FE-1 levels were significantly lower in OAGB and SADS groups compared to SG and controls.
• A strong inverse correlation was observed between EWL and FE-1 levels.
• PERT successfully increased FE-1 levels in OAGB and SADS patients, with no adverse effect on weight loss or BMI.
• Vitamin D levels showed some variation across groups, with a significant difference noted (p=0.04).

Conclusions:

• Malabsorption is prevalent after OAGB and SADS, but not typically after SG, as indicated by FE-1 levels.
• PERT is effective in restoring pancreatic function post-bariatric surgery without compromising weight loss.
• PERT may also contribute to normalizing vitamin D levels.