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Impact of Probiotics on Gastrointestinal Function and Metabolic Status After Roux-en-Y Gastric Bypass: A Double-Blind, Randomized Trial

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Abstract

Purpose

Postoperative changes in gut microbiota may occur in patients undergoing Roux-en-Y gastric bypass surgery. In this study, we evaluate the impact of administering probiotic tablets on the gastrointestinal function and metabolic status of these patients.

Materials and Methods

This double-blinded randomized clinical trial was conducted from 2021 to 2022 on 135 Roux-en-Y surgery candidates. The intervention group underwent the surgical procedure and started receiving probiotic supplements (Familact Co.) 1 week after surgery; the control group received a placebo. The laboratory and anthropometric data were measured and analyzed before and 3 and 6 months after the intervention. GIQLI questionnaire was also used at the beginning and 6 months after the intervention to evaluate GI symptoms.

Results

We observed significantly reduced BMI in both groups after surgeries (P < 0.001). The levels of FBS and HbA1C were significantly lower in the probiotic group compared to the placebo in 3 months (P = 0.02 and P = 0.001, respectively) and 6 months (P < 0.001 for both) after the intervention. The levels of vitamin B12 increased significantly in the probiotic group (P < 0.001), and the values were substantially higher than the placebo group in 3 and 6 months (P < 0.001), respectively. Analysis of the GIQLI questionnaire before and 6 months after interventions also revealed significant improvement in the GIQLI score in both groups (P < 0.001 for probiotics and P = 0.03 for placebo).

Conclusion

Probiotic supplement administration following RYGB improves patients’ vitamin and metabolic profile, as well as GI function, although it cannot significantly affect weight loss.

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References

  1. Upadhyay J, Farr O, Perakakis N, et al. Obesity as a disease. Med Clin. 2018;102(1):13–33.

    Google Scholar 

  2. Babak A, Rouzbahani R, Nejad RK, et al. Comparison of nutritional behaviors and physical activities between overweight/obese and normal-weight adults. Adv Biomed Res. 2019;8.

  3. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6–10.

    Article  CAS  PubMed  Google Scholar 

  4. Bray GA, Frühbeck G, Ryan DH, et al. Management of obesity. Lancet. 2016;387(10031):1947–56.

    Article  PubMed  Google Scholar 

  5. Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020;324(9):879–87.

    Article  PubMed  Google Scholar 

  6. Lupoli R, Lembo E, Saldalamacchia G, et al. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pucci A, Batterham R. Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest. 2019;42(2):117–28.

    Article  CAS  PubMed  Google Scholar 

  8. Wang L, Yao L, Yan P, et al. Robotic versus laparoscopic Roux-en-Y gastric bypass for morbid obesity: a systematic review and meta-analysis. Obes Surg. 2018;28(11):3691–700.

    Article  PubMed  Google Scholar 

  9. Guan B, Yang J, Chen Y, et al. Nutritional deficiencies in Chinese patients undergoing gastric bypass and sleeve gastrectomy: prevalence and predictors. Obes Surg. 2018;28(9):2727–36.

    Article  PubMed  Google Scholar 

  10. Lombardo M, Franchi A, Padua E, et al. Potential nutritional deficiencies in obese subjects 5 years after bariatric surgery. Bariatric Surg Pract Patient Care. 2019;14(3):125–30.

    Article  Google Scholar 

  11. Patterson E, Ryan PM, Cryan JF, et al. Gut microbiota, obesity and diabetes. Postgrad Med J. 2016;92(1087):286–300.

    Article  CAS  PubMed  Google Scholar 

  12. Antoniewicz A, Kalinowski P, Kotulecka KJ, et al. Nutritional deficiencies in patients after Roux-en-Y gastric bypass and sleeve gastrectomy during 12-month follow-up. Obes Surg. 2019;29(10):3277–84.

    Article  PubMed  Google Scholar 

  13. Gérard P. Gut microbiota and obesity. Cell Mol Life Sci. 2016;73(1):147–62.

    Article  PubMed  Google Scholar 

  14. Keleidari B, Mahmoudie M, Anaraki AG, et al. Six month-follow up of laparoscopic sleeve gastrectomy. Adv Biomed Res. 2016;5.

  15. Zheng Z, Hu Y, Tang J, et al. The implication of gut microbiota in recovery from gastrointestinal surgery. Front Cell Infect Microbiol. 2023;13:1110787.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lyo V, Plescia T, Chirco AR. The impact of bariatric surgery on the development of small intestinal bacterial overgrowth (SIBO). J Am Coll Surg. 2021;233(5, Supplement 2):e9–10.

    Article  Google Scholar 

  17. Baothman OA, Zamzami MA, Taher I, et al. The role of gut microbiota in the development of obesity and diabetes. Lipids Health Dis. 2016;15(1):1–8.

    Article  Google Scholar 

  18. Barathikannan K, Chelliah R, Rubab M, et al. Gut microbiome modulation based on probiotic application for anti-obesity: a review on efficacy and validation. Microorganisms. 2019;7(10):456.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Dahiya DK, Puniya M, Shandilya UK, et al. Gut microbiota modulation and its relationship with obesity using prebiotic fibers and probiotics: a review. Front Microbiol. 2017;8:563.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Eypasch E, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg. 1995;82(2):216–22.

    Article  CAS  PubMed  Google Scholar 

  21. Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204.

    Article  PubMed  Google Scholar 

  22. Fernandes R, Beserra BT, Mocellin MC, et al. Effects of prebiotic and synbiotic supplementation on inflammatory markers and anthropometric indices after Roux-en-Y Gastric bypass: a randomized, triple-blind, placebo-controlled pilot study. J Clin Gastroenterol. 2016;50(3):208–17.

    Article  CAS  PubMed  Google Scholar 

  23. Ramos MRZ, de Oliveira CL, Wagner NRF, et al. Effects of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 supplementation on nutritional and metabolic parameters in the early postoperative period after Roux-en-Y gastric bypass: a randomized, double-blind, placebo-controlled trial. Obes Surg. 2021;31(5):2105–14.

    Article  PubMed  Google Scholar 

  24. Cook J, Lehne C, Weiland A, et al. Gut microbiota, probiotics and psychological states and behaviors after bariatric surgery—a systematic review of their interrelation. Nutrients. 2020;12(8):2396.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ciobârcă D, Cătoi AF, Copăescu C, et al. Bariatric surgery in obesity: effects on gut microbiota and micronutrient status. Nutrients. 2020;12(1):235.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gutiérrez-Repiso C, Moreno-Indias I, Tinahones FJ. Shifts in gut microbiota and their metabolites induced by bariatric surgery. Impact of factors sha** gut microbiota on bariatric surgery outcomes. Rev Endocr Metab Disord. 2021;1–20.

  27. Abenavoli L, Scarpellini E, Colica C, et al. Gut microbiota and obesity: a role for probiotics. Nutrients. 2019;11(11):2690.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Chen J-C, Lee W-J, Tsou J-J, et al. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(1):57–61.

    Article  PubMed  Google Scholar 

  29. Swierz MJ, Storman D, Staskiewicz W, et al. Efficacy of probiotics in patients with morbid obesity undergoing bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2020;16(12):2105–16.

    Article  PubMed  Google Scholar 

  30. Wagner NRF, Ramos MRZ, de Oliveira CL, et al. Effects of probiotics supplementation on gastrointestinal symptoms and SIBO after Roux-en-Y gastric bypass: a prospective, randomized, double-blind, placebo-controlled trial. Obes Surg. 2021;31(1):143–50.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Isfahan Minimally Invasive Surgery and Obesity Research Center, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Hamid Melali, Erfan Sheikhbahaei, Mohsen Mahmoudieh & Behrouz Keleidari

  2. Department of General Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran

    Alimeh Abdolahi

  3. Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Hazrat-E Rasool General Hospital, Masouri St. Niyayesh St. Satarkhan Ave., Tehran, 14665-354, Iran

    Erfan Sheikhbahaei & Shahab Shahabi

  4. Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Kimia Vakili

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  1. Hamid Melali
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Correspondence to Shahab Shahabi.

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Ethical Approval

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 (Ethics code: IR.MUI.MED.REC.1399.849, Iranian Registry of Clinical Trials (IRCT) code: IRCT20220702055340N1).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key points

• Bariatric surgery is effective in lowering the BMI and improving the metabolic profile and subjective GI symptoms in patients with obesity.

• Probiotics could result in a more significant post-op reduction in FBS and HbA1C.

• An increase in vitamin B12 level and GIQLI scores compared to placebo was observed in patients who received probiotics.

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Melali, H., Abdolahi, A., Sheikhbahaei, E. et al. Impact of Probiotics on Gastrointestinal Function and Metabolic Status After Roux-en-Y Gastric Bypass: A Double-Blind, Randomized Trial. OBES SURG 34, 2033–2041 (2024). https://doi.org/10.1007/s11695-024-07225-1

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  • DOI: https://doi.org/10.1007/s11695-024-07225-1

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