The gastrointestinal tract is known to generate hormonal and neural signals that can affect the endocrine function of the pancreas ("enteroinsular axis"). The physiological circumstances under which this connection is operative are still a matter of debate. We investigated the influence of bile flow on glucose homeostasis in an experimental model of internal biliary diversion. After laparotomy in 2-mo-old rats, bile flow was diverted from the duodenum into the second jejunal loop with the use of a plastic minicannula. Rats in which the cannula was implanted but not connected with the common bile duct (sham operation) and rats receiving no treatment were used as control groups. After surgery, the rats with the biliary bypass weighed 10% less than the controls for 3 wk; afterwards and until 9 mo later, operated and nonoperated animals had similar growth curves. After the operation, fasting plasma glucose concentrations fell significantly in the treated rats compared with both sham-operated and control rats; likewise, the glycemic response to orally administered glucose was lower in the treated group 1 wk after surgery. In contrast, no significant difference was found in either the fasting or the glucose-induced plasma insulin levels. Nine months after surgery, the same three groups of animals received an oral glucose tolerance test, an intravenous glucose tolerance test, and a fasting-refeeding test (24 h of fast followed by standard, mixed feeding for another 24 h). On all three tests, bile-diverted rats showed lower plasma glucose responses than either sham-operated or control rats in the face of essentially similar plasma insulin responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Previous experimental indications that the internal biliary diversion (IBD), consisting in bilio-jejunal anastomosis, provokes an increase in glucose tolerance in healthy rats provide the basis for testing the hypothesis that this surgical procedure is capable of correcting pharmacologically-induced diabetes mellitus. To this object, the carbohydrate metabolism of an experimental group of six rats suffering from streptozotocin diabetes and treated with IBD (Lambert prosthetic choledoco-jejunostomy) was studied and compared with that of three control groups: normal, diabetic without surgery and diabetic with sham-surgery. Carbohydrate metabolism, assessed during 60-day period by means of specific tests (basal and fasting blood glucose and insulin, glucose tolerance and insulin sensitivity), demonstrated that the IBD provokes a definitive remission, either total or partial, of the artificial diabetes mellitus. The results lead to the hypothetical explanation that diversion of bile flow from the duodenum to the proximal jejunum activates the 'entero-insular axis', specifically by potentiating the B-cell stimulating effect of the so-called enteric hormone 'incretin'.

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