TY - JOUR

T1 - Peripheral and Cardiovascular Autonomic Neuropathy After Roux-en-Y Gastric Bypass Surgery

T2 - a Pilot Study

AU - Christensen, Marie Mathilde Bjerg

AU - Hansen, Christian Stevns

AU - Karlsson, Páll

AU - Dirksen, Carsten

N1 - Funding Information: M.M.B.C., C.S.H., and C.D. declare that they have no conflict of interest. P.K. has received personal fees from Grünenthal, Alnylam and Vertex, and has received research grants outside the submitted work from Merck and the Novo Nordisk Foundation (grant number NNF18OC0052301).

PY - 2023

Y1 - 2023

N2 - Bariatric surgery (BS) effectively treats severe obesity and metabolic diseases [1], but carries a risk of impaired absorption of micronutrients (e.g., vitamins like D, B12, and thiamine, and trace elements like iron, zinc, copper, and calcium) [2] and increased postprandial glucose variability [3]. This is particularly true for BS procedures that involve intestinal bypass such as the widespread Roux-en-Y gastric bypass (RYGB) procedure. Therefore, patients with RYGB surgery are prone to complications such as iron deficiency anemia, insufficiency of vitamin D, B12 or thiamine, and post-bariatric hypoglycemia that often develop years after surgery [4, 5].These deficiencies can cause a range of nerve dysfunctions [6,7,8], including peripheral neuropathy (PN) characterized by reduced sensation and pain in extremities [9], and autonomic neuropathy affecting the cardiovascular, gastrointestinal, urogenital, and sudomotor systems [10], but also nutrient deficiency specific conditions such as myelopathy (vitamin B12 and copper), Wernicke’s encephalopathy (thiamine), optic neuropathy, and spinocerebellar syndrome (vitamin E) [6]. Increased glycemic variability with hypoglycemic episodes may contribute to neuropathy development [11]. Thus, we hypothesize that BS patients, especially those with intestinal bypass that are prone to micronutrient malabsorption and with a history of longstanding nutritional deficiencies or hypoglycemic events, may be at increased risk of developing PN and autonomic neuropathy. Prior studies lack comprehensive and objective nerve function assessment, as well as long-term follow-up [7, 8, 12, 13]. In this cross-sectional pilot study, we assessed PN and cardiovascular autonomic neuropathy (CAN) in patients who had undergone RYGB more than 5 years ago and had suspected or confirmed nutritional and/or metabolic post-bariatric complications.

AB - Bariatric surgery (BS) effectively treats severe obesity and metabolic diseases [1], but carries a risk of impaired absorption of micronutrients (e.g., vitamins like D, B12, and thiamine, and trace elements like iron, zinc, copper, and calcium) [2] and increased postprandial glucose variability [3]. This is particularly true for BS procedures that involve intestinal bypass such as the widespread Roux-en-Y gastric bypass (RYGB) procedure. Therefore, patients with RYGB surgery are prone to complications such as iron deficiency anemia, insufficiency of vitamin D, B12 or thiamine, and post-bariatric hypoglycemia that often develop years after surgery [4, 5].These deficiencies can cause a range of nerve dysfunctions [6,7,8], including peripheral neuropathy (PN) characterized by reduced sensation and pain in extremities [9], and autonomic neuropathy affecting the cardiovascular, gastrointestinal, urogenital, and sudomotor systems [10], but also nutrient deficiency specific conditions such as myelopathy (vitamin B12 and copper), Wernicke’s encephalopathy (thiamine), optic neuropathy, and spinocerebellar syndrome (vitamin E) [6]. Increased glycemic variability with hypoglycemic episodes may contribute to neuropathy development [11]. Thus, we hypothesize that BS patients, especially those with intestinal bypass that are prone to micronutrient malabsorption and with a history of longstanding nutritional deficiencies or hypoglycemic events, may be at increased risk of developing PN and autonomic neuropathy. Prior studies lack comprehensive and objective nerve function assessment, as well as long-term follow-up [7, 8, 12, 13]. In this cross-sectional pilot study, we assessed PN and cardiovascular autonomic neuropathy (CAN) in patients who had undergone RYGB more than 5 years ago and had suspected or confirmed nutritional and/or metabolic post-bariatric complications.

KW - Cardiovascular autonomic neuropathy

KW - Nutritional deficiency

KW - Peripheral neuropathy

KW - Post-bariatric complications

KW - Roux-en-Y gastric bypass

U2 - 10.1007/s11695-023-06920-9

DO - 10.1007/s11695-023-06920-9

M3 - Journal article

C2 - 37880464

AN - SCOPUS:85174692227

VL - 33

SP - 4183

EP - 4187

JO - Obesity Surgery

JF - Obesity Surgery

SN - 0960-8923

IS - 12

ER -