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Metabolic improvement in obese patients after duodenal–jejunal exclusion is associated with intestinal microbiota composition changes

International Journal of Obesity volume 43, pages 2509–2517 (2019)Cite this article

Subjects

Abstract

Background

Intestinal microbiota have been suggested to play an important role in the pathogenesis of obesity and type 2 diabetes. Bariatric surgery improves both conditions and has been associated with changes in intestinal microbiota composition. We investigated the effect of a nonsurgical bariatric technique on intestinal microbiota composition in relation to metabolic improvement.

Methods

Seventeen patients with obesity and type 2 diabetes were treated with the nonsurgical duodenal–jejunal bypass liner, which excludes the proximal 60 cm small intestine from food. Fecal samples as well as metabolic parameters reflecting obesity and type 2 diabetes were obtained from the patients at baseline, after 6 months with the device in situ, and 6 months after explantation.

Results

After 6 months of treatment, both obesity and type 2 diabetes had improved with a decrease in weight from 106.1 [99.4–123.5] to 97.4 [89.4–114.0] kg and a decrease in HbA1c from 8.5% [7.6–9.2] to 7.2% [6.3–8.1] (both p < 0.05). This was paralleled by an increased abundance of typical small intestinal bacteria such as Proteobacteria, Veillonella, and Lactobacillus spp. in feces. After removal of the duodenal–jejunal bypass liner, fecal microbiota composition was similar to that observed at baseline, despite persistent weight loss.

Conclusion

Improvement of obesity and type 2 diabetes after exclusion of the proximal 60 cm small intestine by treatment with a nonsurgical duodenal–jejunal bypass liner may be promoted by changes in fecal microbiota composition.

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Acknowledgements

The authors would like to thank the patients contributing to this trial; the trial nurse Y. Wils, the students who helped conducting this research, Dr. R.J. de Ridder, Dr. G.H. Koek, and Dr. C.M. Bakker for their help with the DJBL procedures; and Prof. Dr. A.A. Masclee, Dr. J. Maljaars, Y. Slaats, and Dr. F.J. Verdam for their help regarding the study design.

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Authors and Affiliations

  1. Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands

    C. de Jonge, N. D. Bouvy & S. S. Rensen

  2. Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands

    S. Fuentes, E. G. Zoetendal & W. M. de Vos

  3. Department of General Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands

    R. Nelissen & J. W. Greve

  4. School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands

    W. A. Buurman

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Correspondence to S. S. Rensen.

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Conflict of interest

N.D.B. received an open research grant from GI dynamics. J.W.G. received an open research grant and support for travel to meetings for the study or other purposes from GI dynamics. W.M.d.V. received a Spinoza award and a Gravitation grant (SIAM 024.002.002) of the Netherlands organization for Scientific Research (NWO). All other authors declare that they have no conflict of interest.

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de Jonge, C., Fuentes, S., Zoetendal, E.G. et al. Metabolic improvement in obese patients after duodenal–jejunal exclusion is associated with intestinal microbiota composition changes. Int J Obes 43, 2509–2517 (2019). https://doi.org/10.1038/s41366-019-0336-x

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