Prospectively collected data were compiled to determine how GBP affects serum
calcium,
vitamin D, and PTH. Student t test, Fisher exact test, or linear regression was used to determine significance.
RESULTS:
Calcium,
vitamin D, and PTH levels were drawn on 243 patients following GBP. Forty-one patients had long-limb bypass (LL-GBP), Roux >100 cm, and 202 had short-limb bypass (SL-GBP), Roux < or =100 cm. The mean (+/-SD) postoperative follow-up time was significantly longer in the LL-GBP group (5.7 +/- 2.5 years) than the SL-GBP group (3.1 +/- 3.6 years, P < 0.0001). When corrected for
albumin levels, mean
calcium was 9.3 mg/dL (range, 8.5-10.8 mg/dL), and no difference existed between LL-GBP and SL-GBP patients. For patients with low
vitamin D levels (<8.9 ng/mL), 88.9% had elevated PTH (>65 pg/mL) and 58.0% of patients with normal
vitamin D levels (> or =8.9 ng/mL) had elevated PTH (P < 0.0001). In individuals with
vitamin D levels <30 ng/mL, 55.1% (n = 103) had elevated PTH, and of those with
vitamin D levels > or =30 ng/mL 28.5% (n = 16) had elevated PTH (P = 0.0007). Mean
vitamin D levels were lower in patients who had undergone LL-GBP as opposed to those with SL-GBP, 16.8 +/- 10.8 ng/mL versus 22.7 +/- 11.1 ng/mL (P = 0.0022), and PTH was significantly higher in patients who had a LL-GBP (113.5 +/- 88.0 pg/mL versus 74.5 +/- 52.7 pg/mL, P = 0.0002). There was a linear decrease in
vitamin D (P = 0.005) coupled with a linear increase in PTH (P < 0.0001) the longer patients were followed after GBP.
Alkaline phosphatase levels were elevated in 40.3% of patients and correlated with PTH levels.
CONCLUSION: