Sleeve
gastrectomy (SG) is the second most commonly performed bariatric procedure worldwide. Altered circulating gut
hormones have been suggested to contribute post-operatively to appetite suppression, decreased caloric intake and
weight reduction. In the present study, we report a 22-year-old woman who underwent laparoscopic SG for
obesity (BMI 46 kg/m(2)). Post-operatively, she reported marked appetite reduction, which resulted in excessive
weight loss (1-year post-SG: BMI 22 kg/m(2),
weight loss 52%, >99th centile of 1-year percentage of
weight loss from 453 SG patients). Gastrointestinal (GI) imaging, GI physiology/motility studies and endoscopy revealed no anatomical cause for her symptoms, and psychological assessments excluded an
eating disorder. Despite nutritional supplements and
anti-emetics, her
weight loss continued (BMI 19 kg/m(2)), and she required nasogastric feeding. A random gut
hormone assessment revealed high plasma
peptide YY (PYY) levels. She underwent a 3 h meal study following an overnight fast to assess her subjective appetite and circulating gut
hormone levels. Her fasted
nausea scores were high, with low hunger, and these worsened with nutrient ingestion. Compared to ten other post-SG female patients, her fasted circulating PYY and nutrient-stimulated PYY and active
glucagon-like peptide 1 (GLP1) levels were markedly elevated.
Octreotide treatment was associated with suppressed circulating PYY and GLP1 levels, increased appetite, increased caloric intake and
weight gain (BMI 22 kg/m(2) after 6 months). The present case highlights the value of measuring gut
hormones in patients following
bariatric surgery who present with
anorexia and excessive
weight loss and suggests that
octreotide treatment can produce symptomatic relief and weight regain in this setting.
LEARNING POINTS:
Roux-en-Y gastric bypass and SG produce marked sustained
weight reduction. However, there is a marked individual variability in this reduction, and post-operative
weight loss follows a normal distribution with extremes of 'good' and 'poor' response.Profound
anorexia and excessive
weight loss post-SG may be associated with markedly elevated circulating fasted PYY and post-meal PYY and GLP1 levels.Octreotide treatment can produce symptomatic relief and weight regain for post-SG patients that have an extreme
anorectic and
weight loss response.The present case highlights the value of measuring circulating gut
hormone levels in patients with post-operative
anorexia and extreme
weight loss.