Changes in Bile Acid Profile After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Metabolic Profile and Fatty Liver Disease.
Bile acids (BA) modulate lipid and glucose metabolism in a feedback loop through production of fibroblast growth factor (FGF) 19 in the terminal ileum. Changes in BA after bariatric surgery may lead to improvements in the metabolic syndrome, including fatty liver disease. This study investigated the relationship between BA and metabolic and inflammatory profiles after laparoscopic sleeve gastrectomy (LSG).



Patients undergoing LSG had fasting blood samples taken pre-operatively and 6 months post-surgery. Liver injury was measured using cytokeratin (CK) 18 fragments. BA were measured using liquid chromatography tandem-mass spectrometry. FGF-19 was measured using enzyme-linked immunosorbent assay.



The study included 18 patients (12 females), with mean age 46.3 years (SEM ± 2.9) and BMI 60.1 kg/m(2) (±2.6). After 6 months, patients lost 39.8 kg (±3.1; p < 0.001). Fourteen patients (78 %) had steatosis. FGF-19 increased from median 128.1 (IQR 89.4-210.1) to 177.1 (121.8-288.9, p = 0.045) at 6 months. Although total BA did not change, primary glycine- and taurine-conjugated BA, cholic acid decreased, and secondary BA, glycine-conjugated urodeoxycholic acid increased over the study period. These changes are associated with reduction in insulin resistance, pro-inflammatory cytokines and CK-18 levels.



The profile of individual BA is altered after LSG. These changes occur in the presence of reductions in inflammatory cytokines and markers of liver injury. This study supports evidence from recent animal models that LSG may have an effect on fatty liver through changes in BA metabolism.
Department of Minimally Invasive, Bariatric and Laparoscopic HPB Surgery, King's College Hospital, London, SE5 9RS, UK. ajay.belgaumkar@kcl.ac.uk.
Ajay P
AP
Belgaumkar
Department of Biochemistry, King's College Hospital, London, UK.
Royce P
RP
Vincent
Department of Minimally Invasive, Bariatric and Laparoscopic HPB Surgery, King's College Hospital, London, SE5 9RS, UK.
Kirstin A
KA
Carswell
Institute of Liver Studies, King's College Hospital, London, UK.
Robin D
RD
Hughes
Department of Biochemistry, King's College Hospital, London, UK.
Jamie
J
Alaghband-Zadeh
Institute of Liver Studies, King's College Hospital, London, UK.
Ragai R
RR
Mitry
Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Ireland.
Carel W
CW
le Roux
Department of Minimally Invasive, Bariatric and Laparoscopic HPB Surgery, King's College Hospital, London, SE5 9RS, UK.
Ameet G
AG
Patel
D000293:Adolescent; D000368:Aged; D001647:Bile Acids and Salts / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005234:Fatty Liver / Q000097:blood / Q000150:complications*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D055815:Young Adult
D001647:Bile Acids and Salts; D015415:Biomarkers
Bariatric surgery; Bile acids; Sleeve gastrectomy