Absorptive and digestive function of the jejunum after jejunoileal bypass for treatment of human obesity.

Rates of absorption of leucine, glycylleucine, and glucose, and rates of hydrolysis of maltose were determined in the jejunum of a group of obese persons before and at intervals (between 2 and 20 montsh) after jejunoileal bypass for the treatment of obesity. The leucine absorption rate was significantly reduced after the bypass, but the absorption rates of glycylleucine and glucose as well as the hydrolysis rate of maltose were unchanged. Light microscopic investigation of the jejunal mucosa, obtained by a peroral biopsy technique before and at 7 months after by bypass operation, did not reveal any change in the histological appearance of this tissue. The plasma aminograms of all 7 patients were compared before and at intervals after the bypass operation; all exhibited a constant pattern of change that was characterized by significant decreases in the concentrations of serine and glycine and by significant decreases in the concentrations of valine, isoleucine, leucine, tyrosine, and phenylalanine. This pattern of change, which is characteristic of protein depletion, persisted during the entire period of observation. Two of these 7 patients developed laboratory evidence of hepatic dysfunction. It is concluded that (1) protein depletion is common to all patients with jejunoileal bypass with or without hepatic dysfunction; and (2) protein depletion results in a sustained reduction in free amino acid absorption in the jejunum.