Ileojejunal Transposition Delays Gastric Emptying and Decreases Fecal Water Content in Dogs withTotal Colectomy

Ueno, Takayoshi; Shibata, Chikashi; Naitö, Hiroo; Jin, Xue; Funayama, Yuji; Fukushima, Kouhei; Matsuno, Seiki; Sasaki, Iwao

doi:10.1007/s10350-004-6122-3

Cited by 15 publications

(4 citation statements)

References 25 publications

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“…As predicted from this anatomy, animals with ileal interposition mount highly exaggerated GLP-1, PYY, and enteroglucagon responses to gastric nutrient loads [38][39][40]. These hormonal changes are associated with reductions in gastric emptying, food intake, and body weight in the absence of any gastric restriction or malabsorption [38][39][40][41][42]. Interposed rats also display improved glucose homeostasis [39].…”

mentioning

confidence: 89%

Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery

Cummings

Overduin

Foster-Schubert

et al. 2007

Surgery for Obesity and Related Diseases

131

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Among the panoply of obesity-related co-morbidities that are ameliorated by bariatric surgery, perhaps the most impressive and scientifically interesting is the rapid, dependable resolution of type 2 diabetes. Numerous studies, including a meta-analysis of 22,094 patients, confirm that 83% to 86% of patients with diabetes experience complete remission of their disease after Roux-en-Y gastric bypass (RYGB), subsequently manifesting normal blood glucose and hemoglobin A1c levels after discontinuation of all diabetes medications [1][2][3][4][5]. After biliopancreatic diversion (BPD), the remission rate is greater than 95% [1]. The relatively few patients whose diabetes does not completely resolve after these procedures have typically had their disease for many years [3], and the progressive β-cell failure characteristic of longstanding type 2 diabetes has presumably rendered these individuals' pathology irreversible.What mechanisms could mediate such a profound improvement in diabetes, which is traditionally considered a relentless, progressive disease? The answers to this question could yield insights leading to the discovery of novel diabetes medications. Undoubtedly, massive weight loss plays an important role, especially in consolidating the long-term antidiabetic effects. After bariatric surgery, many physiologic changes have been documented that should improve glucose homeostasis. These include increases in muscle insulin receptor density and adiponectin levels, as well as decreases in the intramuscular and intrahepatic content of total lipids and long-chain fatty acyl-CoA molecules (moieties that cause insulin resistance) [6][7][8]. As predicted from these changes, glucose transport in incubated muscle fibers, whole-body glucose disposal during euglycemic clamps, and insulin sensitivity as measured by minimal modeling all increase dramatically after RYGB-induced weight loss [6,8,9]. BPD improves insulin sensitivity even more than does RYGB [10]. These adaptations, however, have been recorded many months to years after surgery. Because they would be predicted to occur as a consequence of substantial weight loss achieved by any means, such changes do not distinguish the impact on diabetic parameters of bariatric surgery per se from secondary results of weight loss.The most dramatic observation in this arena is that certain bariatric operations cause complete remission of diabetes within days to weeks after surgery-long before substantial weight loss

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mentioning

confidence: 89%

Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery

Cummings

Overduin

Foster-Schubert

et al. 2007

Surgery for Obesity and Related Diseases

131

View full text Add to dashboard Cite

show abstract

“…45 An alternate mechanism, known as the "ileal brake," could also account for weight loss following RYGBP. [77][78][79][80] In this phenomenon, the presence of nutrients in the ileum suppresses gastrointestinal motility, gastric emptying, small intestinal transit, and thus, food intake. This mechanism relies mainly on neural and hormonal satiety signaling to the hypothalamus via PYY 3-36 , (GLP-1), neurotensin, and enteroglucagon, all of which are increased in response to meals after jejuno-ileal bypass.…”

Section: Mechanism Of Weight Loss Following Roux-en-y Gastric Bypassmentioning

confidence: 99%

Pathophysiology of Obesity: Why Surgery Remains the Most Effective Treatment

et al. 2007

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Obesity is a rapidly increasing, worldwide epidemic. Despite recent scientific advances, no currently recommended dietary program or medication results in long-term weight loss of more than 10% of body weight for the vast majority of people who attempt these interventions. Hence, surgical intervention is recommended for patients with a BMI > or =40 kg/m2. Although surgery is an effective, sustainable treatment of obesity, it can be associated with potentially significant perioperative risks and long-term complications. Current research is focused on developing a medical therapy, which produces more effective and sustainable weight loss, yet avoids the risks inherent in major surgery. With a reduced risk profile, such therapy could also be appropriately offered to those who are less obese and, in theory, help those who have BMIs as low as 27 kg/m2. Toward that end, numerous scientists are working to both unravel the pathophysiology of obesity and to determine why surgical intervention is so effective. This review briefly examines the current status of obesity pathophysiology and management, the reasons for failure of conventional medical treatments, and the success of surgical intervention. Finally, future areas of research are discussed.

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“…Here isoperistaltic conduits (particularly the jejunum) could be transformed into protective segments that act either as gastric reservoirs (65,66), post‐gastrectomy segments (67) or gastro‐oesophageal sphincters (68,69). Many of these procedures were experimented upon humans with end‐stage cancer; however, the adoption of bowel interposition techniques in animal models (69) has led to a number of mechanistic insights using dogs and rats which include the development of jejunal neocolons (70), colonic interpositions (71,72), biliary tract interpositions (73,74), gastric pouches (75), jejunal interposition physiology (76,77), pancreatic exocrine activity and carcinogenesis (using jejunal pancreaticobiliary diversion) (78).…”

Section: Ileal Interpositionmentioning

confidence: 99%

Metabolic surgery: an evolution through bariatric animal models

Ashrafian

Bueter

Ahmed³

et al. 2010

Obesity Reviews

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Metabolic surgery was developed through the application and experience gained from bariatric or weight loss procedures. Much of our knowledge from the procedures comes from the study of animal models, where they have revealed anatomic feasibility, systemic physiological elements and cellular metabolic effects. The first generation of operation included the jejunoileal bypass and partial ileal bypass that led to the development of the current procedures including Roux-en-Y gastric bypass, biliopancreatic diversion, adjustable gastric banding and sleeve gastrectomy. These operations carry significant metabolic benefits and can reduce the risk of diabetes, heart disease and cancer. Further insights from these animal models can reveal genetic, molecular and systemic effects that can enhance and develop the next generation of metabolic operations.

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Ileojejunal Transposition Delays Gastric Emptying and Decreases Fecal Water Content in Dogs withTotal Colectomy

Abstract: Ileojejunal transposition delays gastric emptying of solids and decreases fecal water content in dogs with total colectomy, indicating that ileojejunal transposition might be able to improve intractable watery diarrhea after total colectomy.

Cited by 15 publications

References 25 publications

Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery

Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery

Pathophysiology of Obesity: Why Surgery Remains the Most Effective Treatment

Metabolic surgery: an evolution through bariatric animal models

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