Bikram Bal

Centra Southside Community Hospital, USA

Title: Macro and micronutrient deficiencies after Roux-En-Y gastric bypass surgery


Bikram Bal is a board certified Gastroenterologist and Hepatologist currently running the Division of Gastroenterology and Hepatology at Centra Southside Community Hospital in Central Virginia. He completed a three year fellowship in gastroenterology and hepatology from Georgetown University - Washington Hospital Center. He has a keen research interest in post operative care of bariatric surgery patients with a special focus on medical and surgical complications of Roux-En-Y gastric bypass surgery. He has published several papers and a book chapter on this topic.


Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related co-morbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the ‘divided’ Roux-en Y gastric bypass (RYGB). Multiple nutrient deficiencies can develop after RYGB. The major macronutrient deficiency after RYGB is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before RYGB and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Major nutritional complications of bariatric surgery can occur more than 20 years after surgery. Recognition of the clinical presentations of these nutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. Physicians should be able to predict and manage most postoperative nutritional disorders related to RYGB and should be prepared to assess patients for potential referral for expert management. This presentation will deal with an overview of the nutrient deficiencies after RYGB as well as their recognition and treatment.

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