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. 1993 Jul;218(1):91–96. doi: 10.1097/00000658-199307000-00014

Gastric acid secretion and vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity.

C D Smith 1, S B Herkes 1, K E Behrns 1, V F Fairbanks 1, K A Kelly 1, M G Sarr 1
PMCID: PMC1242905  PMID: 8328834

Abstract

OBJECTIVE: This study sought to determine the basal and peak-stimulated acid secretion from the proximal gastric pouch and its relationship to absorption of free and food-bound vitamin B12 after gastric bypass for morbid obesity. SUMMARY BACKGROUND DATA: Gastric bypass can be performed safely and provides acceptable weight loss, but concerns remain about possible long-term complications such as vitamin B12 malabsorption. The authors hypothesized that by constructing a small pouch of gastric cardia, acid secretion into the pouch would be low, leading to maldigestion of food-bound vitamin B12 with subsequent malabsorption. METHODS: Basal and pentagastrin-stimulated peak acid outputs from the proximal gastric pouch were measured in ten patients after vertical Roux-en-Y gastric bypass using a perfused orogastric tube technique. Absorption of free and food-bound 57Co-vitamin B12 was evaluated separately using 24-hour urinary excretion. RESULTS: Basal (mEq/hr, mean +/- standard error of the mean [SEM]) and peak-stimulated (mEq/30 min) acid secretions from the proximal gastric pouch were markedly decreased compared to those for age- and sex-matched hospital control subjects (0.01 +/- 0.01 vs. 4.97 +/- 0.66 and 0.08 +/- 0.04 vs. 12.11 +/- 1.34, respectively; p < 0.001 for each). While absorption of free vitamin B12 was not statistically different from that of control subjects (11 +/- 2 vs. 15 +/- 2%; p > 0.05), absorption of food-bound vitamin B12 was decreased (0.8 +/- 0.2 vs. 3.7 +/- 0.5%; p < 0.01). CONCLUSIONS: After vertical Roux-en-Y gastric bypass for morbid obesity, acid secretion is virtually absent and food-bound vitamin B12 is maldigested and subsequently malabsorbed. The results of this study suggest that postoperative vitamin B12 supplementation is important and can be achieved with either monthly parenteral vitamin B12 or daily oral crystalline preparations.

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Selected References

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  1. Amaral J. F., Thompson W. R., Caldwell M. D., Martin H. F., Randall H. T. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985 Feb;201(2):186–193. doi: 10.1097/00000658-198502000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Avinoah E., Ovnat A., Charuzi I. Nutritional status seven years after Roux-en-Y gastric bypass surgery. Surgery. 1992 Feb;111(2):137–142. [PubMed] [Google Scholar]
  3. Benotti P. N., Hollingshead J., Mascioli E. A., Bothe A., Jr, Bistrian B. R., Blackburn G. L. Gastric restrictive operations for morbid obesity. Am J Surg. 1989 Jan;157(1):150–155. doi: 10.1016/0002-9610(89)90438-8. [DOI] [PubMed] [Google Scholar]
  4. Carmel R., Sinow R. M., Karnaze D. S. Atypical cobalamin deficiency. Subtle biochemical evidence of deficiency is commonly demonstrable in patients without megaloblastic anemia and is often associated with protein-bound cobalamin malabsorption. J Lab Clin Med. 1987 Apr;109(4):454–463. [PubMed] [Google Scholar]
  5. Crowley L. V., Olson R. W. Megaloblastic anemia after gastric bypass for obesity. Am J Gastroenterol. 1983 Jul;78(7):406–410. [PubMed] [Google Scholar]
  6. Crowley L. V., Seay J., Mullin G. Late effects of gastric bypass for obesity. Am J Gastroenterol. 1984 Nov;79(11):850–860. [PubMed] [Google Scholar]
  7. Doscherholmen A., McMahon J., Ripley D. Impaired absorption of egg vitamin B 12 in postgastrectomy and achlorhydric patients. J Lab Clin Med. 1971 Nov;78(5):839–840. [PubMed] [Google Scholar]
  8. Doscherholmen A., Silvis S., McMahon J. Dual isotope Schilling test for measuring absorption of food-bound and free vitamin B12 simultaneously. Am J Clin Pathol. 1983 Oct;80(4):490–495. doi: 10.1093/ajcp/80.4.490. [DOI] [PubMed] [Google Scholar]
  9. Doscherholmen A., Swaim W. R. Impaired assimilation of egg Co 57 vitamin B 12 in patients with hypochlorhydria and achlorhydria and after gastric resection. Gastroenterology. 1973 May;64(5):913–919. [PubMed] [Google Scholar]
  10. Festen H. P. Intrinsic factor secretion and cobalamin absorption. Physiology and pathophysiology in the gastrointestinal tract. Scand J Gastroenterol Suppl. 1991;188:1–7. doi: 10.3109/00365529109111222. [DOI] [PubMed] [Google Scholar]
  11. Flickinger E. G., Pories W. J., Meelheim H. D., Sinar D. R., Blose I. L., Thomas F. T. The Greenville gastric bypass. Progress report at 3 years. Ann Surg. 1984 May;199(5):555–562. doi: 10.1097/00000658-198405000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Flickinger E. G., Sinar D. R., Swanson M. Gastric bypass. Gastroenterol Clin North Am. 1987 Jun;16(2):283–292. [PubMed] [Google Scholar]
  13. Griffen W. O., Jr, Bivins B. A., Bell R. M., Jackson K. A. Gastric bypass for morbid obesity. World J Surg. 1981 Nov;5(6):817–822. doi: 10.1007/BF01657968. [DOI] [PubMed] [Google Scholar]
  14. Halverson J. D. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg. 1986 Nov;52(11):594–598. [PubMed] [Google Scholar]
  15. Jordan J. H., Hocking M. P., Rout W. R., Woodward E. R. Marginal ulcer following gastric bypass for morbid obesity. Am Surg. 1991 May;57(5):286–288. [PubMed] [Google Scholar]
  16. Kittang E., Schjønsby H. Effect of gastric anacidity on the release of cobalamins from food and their subsequent binding to R-protein. Scand J Gastroenterol. 1987 Nov;22(9):1031–1037. doi: 10.3109/00365528708991952. [DOI] [PubMed] [Google Scholar]
  17. Knecht B. H. Mason gastric bypass. Long-term follow-up and comparison with other gastric procedures. Am J Surg. 1983 May;145(5):604–608. doi: 10.1016/0002-9610(83)90102-2. [DOI] [PubMed] [Google Scholar]
  18. Kral J. G., Heymsfield S. Morbid obesity: definitions, epidemiology, and methodological problems. Gastroenterol Clin North Am. 1987 Jun;16(2):197–205. [PubMed] [Google Scholar]
  19. Linner J. H. Overview of surgical techniques for the treatment of morbid obesity. Gastroenterol Clin North Am. 1987 Jun;16(2):253–272. [PubMed] [Google Scholar]
  20. Marcuard S. P., Sinar D. R., Swanson M. S., Silverman J. F., Levine J. S. Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity. Dig Dis Sci. 1989 Aug;34(8):1238–1242. doi: 10.1007/BF01537272. [DOI] [PubMed] [Google Scholar]
  21. Peltier G., Hermreck A. S., Moffat R. E., Hardin C. A., Jewell W. R. Complications following gastric bypass procedures for morbid obesity. Surgery. 1979 Oct;86(4):648–654. [PubMed] [Google Scholar]
  22. Printen K. J., Scott D., Mason E. E. Stomal ulcers after gastric bypass. Arch Surg. 1980 Apr;115(4):525–527. doi: 10.1001/archsurg.1980.01380040147026. [DOI] [PubMed] [Google Scholar]
  23. Salom I. L., Silvis S. E., Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol. 1982 Jan;17(1):129–131. doi: 10.3109/00365528209181056. [DOI] [PubMed] [Google Scholar]
  24. Schilling R. F., Gohdes P. N., Hardie G. H. Vitamin B12 deficiency after gastric bypass surgery for obesity. Ann Intern Med. 1984 Oct;101(4):501–502. doi: 10.7326/0003-4819-101-4-501. [DOI] [PubMed] [Google Scholar]
  25. Sugerman H. J., Starkey J. V., Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987 Jun;205(6):613–624. doi: 10.1097/00000658-198706000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]

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