Acquired copper deficiency post Roux-en-Y gastric bypass surgery: A retrospective review

Thesis (Master's)--University of Washington, 2013Copper is an essential trace element which operates as a vital cofactor in enzymatic reactions crucial to normal function of the hematologic, vascular, skeletal, and the nervous systems. It is also a key component of the antioxidant system. The site of copper absorption in humans is primarily the stomach and the proximal small intestine. Copper deficiency is associated with a spectrum of aberrations including neurologic manifestations such as sensory ataxia secondary to dorsal column dysfunction, gait difficulties, proprioceptive deficits, and paresthesias; hematologic abnormalities such as hypochromic anemia with neutropenia and leukopenia; as well as myeloneuropathy. The neurologic symptoms may closely resemble the myeloneuropathy indicative of a vitamin B12 deficiency and may be irrevocable if not treated. However, there is currently no consensus on an appropriate copper repletion regimen making awareness and early diagnosis critical. Though hypocupremia is rare in the general public it has been described in the setting of gastric-bypass surgery. The Roux-en-Y gastric bypass (RYGB) procedure is a successful surgical treatment for morbid obesity. The number of RYGB surgeries performed in the United States is dramatically increasing in tandem with the country's rising obesity rates. Most RYGB procedures bypass the duodenum as well as 100-200 cm of the proximal jejunum, where copper absorption takes place. Little information on how this procedure affects copper status in the long term is currently available. Most studies are focusing on the micronutrient status of more common deficiencies such as vitamin B12, iron, thiamine, folate, vitamin D, and folate; both pre-operative status or the first five years post-operatively. With symptoms mimicking several of these deficiencies, a copper deficiency may in fact be unrecognized and under-reported in the bariatric population. With a burgeoning number of patients undergoing malabsorptive surgical procedures for obesity treatment, this strongly suggests the incidence of copper depletion and hematologic and neurologic derangements will increase in the future