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Medical Rounds

Gastroenterology: Bypassing Bypass Surgery

Gastroenterologist Ashish Nimgaonkar is on his way to reproducing a beneficial byproduct of a gastric bypass using neither surgery nor endoscopy. He is engineering a pill that will mimic not only the weight loss effects but also the glycemic benefits of a gastric bypass procedure.

When patients first underwent gastric bypass surgery, the obvious benefit was dramatic weight loss. But patients who happened to have type 2 diabetes enjoyed an additional, unexpected outcome. “A few days after the surgery, they were walking out of the hospital without a need for insulin or diabetes medicine,” says Nimgaonkar. It turns out, he explains, that “rerouting food past the duodenum during the digestion process has a tremendous and immediate effect on glycemic control.”

Nimgaonkar, gastroenterologist Jay Pasricha and biomedical engineer Kevin Colbert are developing a pill that will deploy a polymer that creates a barrier to the same part of the small intestine that is bypassed in gastric bypass surgery, producing similar weight loss and glycemic benefits as a surgical or endoscopic procedure. 

The concept: A patient swallows the pill before a meal, and it activates upon contact with the duodenum. This allows food to pass untouched from the pylorus to the jejunum. “It’s still at a very early stage,” says Nimgaonkar. “But we have shown that it works in animal models.”

Nimgaonkar and his team won a $500,000 prize for the pill’s concept in an international competition sponsored by a large multinational drugmaker. They continue to engineer the pill to optimize the dose, properties and delivery system for the polymer, and will soon embark on clinical trials.