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Passage Obesity Is a Condition That Affects Over 30% of Adults

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Obesity is a condition that affects over 30% of adults in the United States and is associated with comorbidities such as type 2 diabetes mellitus, heart disease, and cancer.  For individuals with clinically severe obesity, defined as having a body mass index above 40 kg/m2, lifestyle interventions may produce insufficient weight reduction.  Weight loss surgery, such as Roux-en-Y gastric bypass (RYGB) , has proved to be the most effective clinical intervention for facilitating massive and immediate weight loss in clinically obese patients.In RYGB, the stomach is first divided into a small gastric pouch and a distal gastric remnant, which remains attached to the duodenum.  Next, the jejunum is transected and its lower section is connected to the newly created gastric pouch to form the alimentary limb.  This connection is typically created with surgical staples.  The formation of the alimentary limb allows ingested food to bypass the region composed of the distal gastric remnant, the duodenum, and the upper jejunum; collectively termed the biliopancreatic limb.  Finally, the lumen of the upper jejunum is reconnected to the lumen of the lower jejunum to allow enzymes and compounds to flow freely from the biliopancreatic limb into the alimentary limb.
Passage Obesity is a condition that affects over 30% of adults in the United States and is associated with comorbidities such as type 2 diabetes mellitus, heart disease, and cancer.  For individuals with clinically severe obesity, defined as having a body mass index above 40 kg/m<sup>2</sup>, lifestyle interventions may produce insufficient weight reduction.  Weight loss surgery, such as Roux-en-Y gastric bypass (RYGB) , has proved to be the most effective clinical intervention for facilitating massive and immediate weight loss in clinically obese patients.In RYGB, the stomach is first divided into a small gastric pouch and a distal gastric remnant, which remains attached to the duodenum.  Next, the jejunum is transected and its lower section is connected to the newly created gastric pouch to form the alimentary limb.  This connection is typically created with surgical staples.  The formation of the alimentary limb allows ingested food to bypass the region composed of the distal gastric remnant, the duodenum, and the upper jejunum; collectively termed the biliopancreatic limb.  Finally, the lumen of the upper jejunum is reconnected to the lumen of the lower jejunum to allow enzymes and compounds to flow freely from the biliopancreatic limb into the alimentary limb. <strong>Figure 1</strong>  RYGB surgically divides the digestive tract into the alimentary limb and the biliopancreatic limb, which then merge into the common limb.RYGB facilitates weight loss by reducing the functional volume of the stomach and altering intestinal anatomy to induce nutrient malabsorption.  However, the procedure is associated with several complications, such as steatorrhea, or fatty stools, due to disruption of lipid digestion.  Animal studies also suggest that RYGB promotes the growth of weight loss-inducing gut bacteria.  Researchers have found that transplanting gut microbiota of obese postoperative RYGB mice into nonoperated, obese mice lacking gut flora may reproduce the therapeutic effects of RYGB in transplant-recipient mice. Adapted from Bächler T, Le roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?. Clin Exp Gastroenterol. 2016;9:181-9. -Nonsteroidal anti-inflammatory drugs (NSAIDs) are weakly acidic compounds that normally pass through the acidic environment of the stomach in a nonionized form until they reach the small intestine, where they become ionized in the less acidic lumen.  Ionized NSAIDs, shown below, are more soluble and therefore dissolve faster. Would NSAID solubility in the gastric pouch of postoperative RYGB patients be higher than normal? A) No, because RYGB decreases the pH of gastric juice B) No, because RYGB increases the pH of gastric juice C) Yes, because RYGB increases the pH of gastric juice D) Yes, because RYGB decreases the pH of gastric juice Figure 1  RYGB surgically divides the digestive tract into the alimentary limb and the biliopancreatic limb, which then merge into the common limb.RYGB facilitates weight loss by reducing the functional volume of the stomach and altering intestinal anatomy to induce nutrient malabsorption.  However, the procedure is associated with several complications, such as steatorrhea, or fatty stools, due to disruption of lipid digestion.  Animal studies also suggest that RYGB promotes the growth of weight loss-inducing gut bacteria.  Researchers have found that transplanting gut microbiota of obese postoperative RYGB mice into nonoperated, obese mice lacking gut flora may reproduce the therapeutic effects of RYGB in transplant-recipient mice.
Adapted from Bächler T, Le roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?. Clin Exp Gastroenterol. 2016;9:181-9.
-Nonsteroidal anti-inflammatory drugs (NSAIDs) are weakly acidic compounds that normally pass through the acidic environment of the stomach in a nonionized form until they reach the small intestine, where they become ionized in the less acidic lumen.  Ionized NSAIDs, shown below, are more soluble and therefore dissolve faster. Passage Obesity is a condition that affects over 30% of adults in the United States and is associated with comorbidities such as type 2 diabetes mellitus, heart disease, and cancer.  For individuals with clinically severe obesity, defined as having a body mass index above 40 kg/m<sup>2</sup>, lifestyle interventions may produce insufficient weight reduction.  Weight loss surgery, such as Roux-en-Y gastric bypass (RYGB) , has proved to be the most effective clinical intervention for facilitating massive and immediate weight loss in clinically obese patients.In RYGB, the stomach is first divided into a small gastric pouch and a distal gastric remnant, which remains attached to the duodenum.  Next, the jejunum is transected and its lower section is connected to the newly created gastric pouch to form the alimentary limb.  This connection is typically created with surgical staples.  The formation of the alimentary limb allows ingested food to bypass the region composed of the distal gastric remnant, the duodenum, and the upper jejunum; collectively termed the biliopancreatic limb.  Finally, the lumen of the upper jejunum is reconnected to the lumen of the lower jejunum to allow enzymes and compounds to flow freely from the biliopancreatic limb into the alimentary limb. <strong>Figure 1</strong>  RYGB surgically divides the digestive tract into the alimentary limb and the biliopancreatic limb, which then merge into the common limb.RYGB facilitates weight loss by reducing the functional volume of the stomach and altering intestinal anatomy to induce nutrient malabsorption.  However, the procedure is associated with several complications, such as steatorrhea, or fatty stools, due to disruption of lipid digestion.  Animal studies also suggest that RYGB promotes the growth of weight loss-inducing gut bacteria.  Researchers have found that transplanting gut microbiota of obese postoperative RYGB mice into nonoperated, obese mice lacking gut flora may reproduce the therapeutic effects of RYGB in transplant-recipient mice. Adapted from Bächler T, Le roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?. Clin Exp Gastroenterol. 2016;9:181-9. -Nonsteroidal anti-inflammatory drugs (NSAIDs) are weakly acidic compounds that normally pass through the acidic environment of the stomach in a nonionized form until they reach the small intestine, where they become ionized in the less acidic lumen.  Ionized NSAIDs, shown below, are more soluble and therefore dissolve faster. Would NSAID solubility in the gastric pouch of postoperative RYGB patients be higher than normal? A) No, because RYGB decreases the pH of gastric juice B) No, because RYGB increases the pH of gastric juice C) Yes, because RYGB increases the pH of gastric juice D) Yes, because RYGB decreases the pH of gastric juice Would NSAID solubility in the gastric pouch of postoperative RYGB patients be higher than normal?


A) No, because RYGB decreases the pH of gastric juice
B) No, because RYGB increases the pH of gastric juice
C) Yes, because RYGB increases the pH of gastric juice
D) Yes, because RYGB decreases the pH of gastric juice

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