Clinical Scorecard: Alterations in Oral and Gut Microbiota Following Sleeve Gastrectomy and Roux-En-Y Gastric Bypass and Their Effects on Bariatric Surgery Outcomes

At a Glance

Key Highlights

• Bariatric surgeries, specifically sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), significantly alter oral and gut microbiota composition.
• Changes in microbiota composition post-surgery may relate to weight-loss outcomes measured at 6 months.
• Current evidence on microbiota changes post-bariatric surgery is limited, especially in human oral and large intestine samples, warranting further research.

Guideline-Based Recommendations

Diagnosis

• Qualification for bariatric surgery based on BMI criteria (≥35 kg/m2 with comorbidities or ≥40 kg/m2) and clinical evaluation.
• Exclude patients with recent antibiotic or probiotic use, oral or gastrointestinal infections, inflammatory bowel disease, thyroid disease, cancer history, or immunodeficiency.

Management

• Selection of SG or RYGB should be a consensus decision between patient and surgeon due to lack of precise qualification criteria.
• Use Enhanced Recovery After Surgery (ERAS) protocols for perioperative care.

Monitoring & Follow-up

• Assess weight-loss outcomes at 6 months post-surgery using %EWL, %TBWL, and %EBMIL.
• Divide patients into successful (≥50% EWL) and unsuccessful (<50% EWL) groups for outcome evaluation.

Risks

• Potential confounding effects of antibiotics, probiotics, infections, and other comorbidities on microbiota composition.
• Variability in microbiota changes depending on type of bariatric surgery performed.

Patient & Prescribing Data

Adults undergoing SG or RYGB for morbid obesity with or without obesity-related comorbidities.

Microbiota alterations post-bariatric surgery may influence weight-loss success; however, precise predictive markers and treatment tailoring based on microbiota remain under investigation.

Clinical Best Practices

• Ensure strict inclusion and exclusion criteria to minimize confounding factors affecting microbiota analysis.
• Collect oral and fecal samples under standardized conditions with appropriate fasting and sterile techniques.
• Store biological samples at −80°C promptly to preserve bacterial DNA integrity for analysis.
• Use rigorous contamination control measures during DNA extraction and sequencing.
• Apply ERAS protocols to optimize perioperative patient recovery.

References

• Obesity and microbiota relationship
• Effectiveness of bariatric surgery
• Common bariatric procedures
• Animal studies on microbiota changes post-bariatric surgery
• STROBE checklist for observational studies
• Criteria for bariatric surgery qualification
• Enhanced Recovery After Surgery (ERAS) protocol
• Sample storage and DNA stability protocols