Gastrointestinal Permeability After Bariatric Surgery: A Systematic Review

Area of Science:

• Gastrointestinal physiology
• Metabolic disease research
• Surgical outcomes

Background:

• Gastrointestinal permeability, the movement of substances across the gut wall, is linked to endotoxemia and metabolic disease.
• The impact of bariatric surgery on gut permeability is not well understood, with potential influences from weight, diet, and metabolic shifts.

Purpose of the Study:

• To systematically review and analyze the existing evidence on the effects of bariatric surgery on gastrointestinal permeability.

Main Methods:

• A systematic review was conducted using MEDLINE, EMBASE, and Scopus databases up to February 2023.
• Search terms included "intestinal permeability" and "bariatric".
• Included studies reported in vivo assessment of permeability; three cohort studies and two case series (n=96) were identified.

Main Results:

• Gastroduodenal permeability decreased after sleeve gastrectomy (SG).
• Small intestinal permeability increased after biliopancreatic diversion but decreased after Roux-en-Y gastric bypass.
• Colonic permeability increased six months post-SG, raising concerns about protein fermentation.

Conclusions:

• Evidence on bariatric surgery's effect on gastrointestinal permeability is conflicting, especially for the small intestine.
• Increased colonic permeability post-SG warrants further investigation regarding potential negative dietary sequelae.
• Multiple factors, including surgical procedure, microbiota, and metabolic responses, confound permeability changes, necessitating further research.