胃分流术引发矿物质吸收不良

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Gastric Bypass Surgery May Cause Post-Op Nutrient Deficiencies

By altering gut ecology, Roux-en-Y gastric bypass surgery may adversely impact absorption of calcium, zinc and possibly other nutrients, according to research presented today in Philadelphia at the 72nd annual scientific meeting of the American College of Gastroenterology.

In a retrospective study, Dr. Timothy R. Koch and colleagues from Washington Hospital Center, Washington, D.C., found that 42 of 43 gastric bypass patients tested had abnormal glucose-hydrogen breath test results, suggesting small intestinal bacterial overgrowth (SIBO). Of these 42 patients, 38 had elevated serum folate, a sensitive marker of SIBO.

\"The bottom line,\" Dr. Koch told Reuters Health, \"is that SIBO is quite common after gastric bypass surgery. We have evidence that even if you take micronutrients after the surgery -- vitamin D, calcium, zinc -- if SIBO is present, they may not be absorbed well and you might still end up with micronutrient deficiency.\"

The researchers also found that 30 patients had low 24-hour urinary calcium levels. \"Gastric bypass patients who have SIBO tend to have normal serum calcium but low 24-hour calcium excretion -- and that suggests SIBO may interfere with calcium or vitamin D absorption from the gut.\"

\"Calcium malabsorption and secondary hyperparathyroidism may increase the risk for developing osteopenia, osteoporosis, and ultimately osteomalacia,\" the authors write in a meeting abstract.

In the same group of patients, Dr. Koch and colleagues found a positive correlation between small intestinal bacterial overgrowth and zinc deficiencies.

\"We found that zinc deficiency is also common in patients with SIBO after gastric bypass surgery. This may be a potential reason for the development of marginal ulcers after the surgery,\" Dr. Koch noted.

\"A percentage of patients after the surgery will develop an ulceration of the jejunum where it is attached to the gastric pouch,\" he explained, \"despite the fact that these patients are achlorhydric, having no acid production following gastric bypass surgery.\"

\"In the past year, several surgical groups have suggested that Roux-en-Y gastric bypass surgery might be a good procedure for refractory GERD (gastroesophageal reflux disease).\"