Impact of Gastric Bypass Surgery on Gut Hormones and Glucose Homeostasis in Type 2 Diabetes

Abstract

Gastric bypass surgery (GBP) for obesity, by constructing an isolated ϳ30-ml proximal gastric pouch connected to a 75-cm limb of proximal jejunum, bypassing >90% of the stomach, the pylorus, and the duodenum, cures type 2 diabetes in >80% of cases. We review alterations in gastrointestinal peptide release after GBP that affect glucose disposal. We focus on ghrelin and the incretins glucosedependent insulinotropic polypeptide, glucagon-like peptide 1, and peptide YY as the most likely candidates for increasing insulin sensitivity after these operations, even before substantial weight loss has occurred. Although we have limited our review to only four gastrointestinal peptides, others may be involved, as are adipocyte-derived molecules such as leptin and adiponectin, and substrate receptor interactions in target tissues including the brain. Diabetes 55 (Suppl. 2):S92-S97, 2006

Weight Regain After Gastric Bypass: Influence of Gut Hormones

“…Considering that changes in the anatomy of the digestive tract after RYGB are accompanied by changes in hormonal secretion, affecting weight control and glucose homeostasis [21][22][23][24][25][26][27][28][29][30][31][32], the outcomes probably improve as these hormonal adjustments persist. These adjustments depend on the emptying of the gastric pouch, and reaching more promptly the small intestine promotes the rapid exposure of the intestinal epithelium to nutrients [33].…”

Traitement de l’obésité sévère par by-pass gastrique : le profil psychologique n’est pas prédictif de la perte de poids au cours de la première année

“…Ainsi, aucun des facteurs psychologiques examinés et, cela par plusieurs types d'analyses, n'arrive à prédire la perte de poids pendant la première année post by-pass gastrique. La disparition de la faim, avec des taux de ghréline qui diminuent parfois en postopératoire, offre probablement aux patients un confort et un contrôle alimentaire qui participent, probablement avec la perte de poids importante, à l'amélioration considérable du profil psychologique après by-pass [38].…”

Bariatric surgery and diabetes remission: how far have we progressed?

“…Fasting leads to raised ghrelin levels, which act on hypothalamus to stimulate appetite and digestive secretions [95]. Ghrelin stimulates glucagon secretion and decreases adiponectin levels, leading to insulin resistance [96,97]. Ghrelin is produced maximally in the gastric fundus.…”