SNFGE SNFGE
 
Thématique :
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2017/04  
 
  2017 Apr;152(5):1055-1067.e3.  
  doi: 10.1053/j.gastro.2017.01.004.  
 
  Steatorrhea and Hyperoxaluria in Severely Obese Patients Before and After Roux-en-Y Gastric Bypass.  
 
  Moreland AM, Santa Ana CA, Asplin JR, Kuhn JA, Holmes RP, Cole JA, Odstrcil EA, Van Dinter TG Jr, Martinez JG, Fordtran JS  
  https://www.ncbi.nlm.nih.gov/pubmed/28089681  
 
 

Abstract

BACKGROUND AND AIMS:

Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) is generally attributed to fat malabsorption. If hyperoxaluria is indeed caused by fat malabsorption, magnitudes of hyperoxaluria and steatorrhea should correlate. Severely obese patients, prior to bypass, ingest excess dietary fat that can produce hyperphagic steatorrhea. The primary objective of the study was to determine whether urine oxalate excretion correlates with elements of fat balance in severely obese patients before and after RYGB.

METHODS:

Fat balance and urine oxalate excretion were measured simultaneously in 26 severely obese patients before and 1 year after RYGB, while patients consumed their usual diet. At these time points, stool and urine samples were collected. Steatorrhea and hyperoxaluria were defined as fecal fat >7 g/day and urine oxalate >40 mg/day. Differences were evaluated using paired 2-tailed t tests.

RESULTS:

Prior to RYGB, 12 of 26 patients had mild to moderate steatorrhea. Average urine oxalate excretion was 61 mg/day; there was no correlation between fecal fat and urine oxalate excretion. After RYGB, 24 of 26 patients had steatorrhea and urine oxalate excretion averaged 69 mg/day, with a positive correlation between fecal fat and urine oxalate excretions (r = 0.71, P < .001). For each 10 g/day increase in fecal fat output, fecal water excretion increased only 46 mL/day.

CONCLUSIONS:

Steatorrhea and hyperoxaluria were common in obese patients before bypass, but hyperoxaluria was not caused by excess unabsorbed fatty acids. Hyperphagia, obesity, or metabolic syndrome could have produced this previously unrecognized hyperoxaluric state by stimulating absorption or endogenous synthesis of oxalate. Hyperoxaluria after RYGB correlated with steatorrhea and was presumably caused by excess fatty acids in the intestinal lumen. Because post-bypass steatorrhea caused little increase in fecal water excretion, most patients with steatorrhea did not consider themselves to have diarrhea. Before and after RYGB, high oxalate intake contributed to the severity of hyperoxaluria.

 
Question posée
 
Chez les patients obèses morbides étudiés avant et après bypass, l’excrétion urinaire d’oxalates est-elle corrélée à la stéatorrhée ?
 
Question posée
 
Dans cette étude portant sur 26 patients ayant une obésité morbide, il existe une hyperoxalurie non corrélée à la stéatorrhée. Chez les mêmes patients étudiés après bypass, l’hyperoxalurie est corrélée à la stéatorrhée, présente chez la majorité des patients, alors que seulement 6/20 rapportent une diarrhée. Avant et après bypass, l’hyperoxalurie est corrélée à la quantité d’oxalates ingérée.
 
Commentaires

L’intérêt de cette étude parait limité, même quand on s’intéresse à la chirurgie bariatrique…

 
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