Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Cavin, Jean‐Baptiste; Couvelard, Anne; Lebtahi, Rachida; Ducroc, Robert; Arapis, Konstantinos; Voitellier, Eglantine; Cluzeaud, Françoise; Gillard, L.; Hourseau, Muriel; Mikaïl, Nidaa; Ribeiro-Parenti, Lara; Kapel, Nathalie; Marmuse, Jean–Pierre; Bado, André; Gall, Maude Le

doi:10.1053/j.gastro.2015.10.009

Cited by 175 publications

(217 citation statements)

References 37 publications

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“…However, emerging evidence suggests that major differences exist between these two procedures regarding glucose uptake (53). After RYGB, the alimentary limb undergoes hyperplasia and hypertrophy, together with increased expression of glucose transporters, increased uptake of glucose into intestinal epithelial cells, and reprogramming of intestinal glucose metabolism to support tissue growth and increased bioenergetic demands.…”

Section: Intestinal Adaptationmentioning

confidence: 99%

“…After RYGB, the alimentary limb undergoes hyperplasia and hypertrophy, together with increased expression of glucose transporters, increased uptake of glucose into intestinal epithelial cells, and reprogramming of intestinal glucose metabolism to support tissue growth and increased bioenergetic demands. The number of cells producing GLP-1 and GIP within the alimentary limb also increases (53). Furthermore, positron emission tomography–computed scanning and biodistribution analysis using 2-deoxy-2-[ 18 F]fluoro- d -glucose in rodents and humans show that the alimentary limb becomes a major site for glucose disposal (53,54).…”

Section: Intestinal Adaptationmentioning

confidence: 99%

“…The number of cells producing GLP-1 and GIP within the alimentary limb also increases (53). Furthermore, positron emission tomography–computed scanning and biodistribution analysis using 2-deoxy-2-[ 18 F]fluoro- d -glucose in rodents and humans show that the alimentary limb becomes a major site for glucose disposal (53,54). These changes are likely to contribute to improved glycemic control.…”

Section: Intestinal Adaptationmentioning

confidence: 99%

“…However, the number and density of cells containing GLP-1 reportedly increase after VSG in rodents. Moreover, VSG reduces intestinal glucose absorption, potentially contributing to improved glucose tolerance (53). These findings yet again highlight that RYGB and VSG improve glucose homeostasis by different—as well as overlapping—mechanisms.…”

Section: Intestinal Adaptationmentioning

confidence: 99%

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Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery

2016

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More than 20 years ago, Pories et al. published a seminal article, “Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus.” This was based on their observation that bariatric surgery rapidly normalized blood glucose levels in obese people with type 2 diabetes mellitus (T2DM), and 10 years later, almost 90% remained diabetes free. Pories et al. suggested that caloric restriction played a key role and that the relative contributions of proximal intestinal nutrient exclusion, rapid distal gut nutrient delivery, and the role of gut hormones required further investigation. These findings of T2DM improvement/remission after bariatric surgery have been widely replicated, together with the observation that bariatric surgery prevents or delays incident T2DM. Over the ensuing two decades, important glucoregulatory roles of the gastrointestinal (GI) tract have been firmly established. However, the physiological and molecular mechanisms underlying the beneficial glycemic effects of bariatric surgery remain incompletely understood. In addition to the mechanisms proposed by Pories et al., changes in bile acid metabolism, GI tract nutrient sensing and glucose utilization, incretins, possible anti-incretin(s), and the intestinal microbiome are implicated. These changes, acting through peripheral and/or central pathways, lead to reduced hepatic glucose production, increased tissue glucose uptake, improved insulin sensitivity, and enhanced β-cell function. A constellation of factors, rather than a single overarching mechanism, likely mediate postoperative glycemic improvement, with the contributing factors varying according to the surgical procedure. Thus, different bariatric/metabolic procedures provide us with experimental tools to probe GI tract physiology. Embracing this approach through the application of detailed phenotyping, genomics, metabolomics, and gut microbiome studies will enhance our understanding of metabolic regulation and help identify novel therapeutic targets.

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Section: Intestinal Adaptationmentioning

confidence: 99%

Section: Intestinal Adaptationmentioning

confidence: 99%

Section: Intestinal Adaptationmentioning

confidence: 99%

Section: Intestinal Adaptationmentioning

confidence: 99%

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Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery

2016

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“…This suggests that while overall nutrient absorption may be decreased, glucose absorption and utilization may be elevated to allow intestinal hypertrophy to occur. A study from Cavin et al [83] lends additional support to the view that gastric bypass causes intestinal hypertrophy and shows that glucose absorption is elevated and glucose becomes trapped within the intestinal epithelial cells. Finally a study from Nguyen et al [84] reports elevated GLUT-1 and 2 expression in the intestine following surgery.…”

Section: Gastric Remodeling and Glucose Utilizationmentioning

confidence: 94%

Longer-Term Physiological and Metabolic Effects of Gastric Bypass Surgery

Mosinski

Kirwan

2016

Curr Diab Rep

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Obesity is closely associated with the development of type 2 diabetes. Many strategies have been used in the past to combat these two conditions, but very few provide for stable and durable glycemic control. Bariatric surgery has emerged as a powerful tool for treating obesity and in over 70 % of cases provides a short-term cure for diabetes. While the acute metabolic effects of surgery are striking, it remains important for us to also consider the long-term effects. This review aims to summarize the chronic or long-term metabolic and physiological effects of Roux-en-Y gastric bypass (RYGB) surgery on pancreatic function, skeletal muscle and hepatic insulin sensitivity, and gastrointestinal remodeling. An increased understanding of the current state of research in these areas can provide the basis for stimulating further research that would contribute to new treatment and management strategies for obesity and diabetes.

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Endocrine Function after Bariatric Surgery

Kim

Sandoval

2017

Comprehensive Physiology

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Obesity increases the risks of metabolic disorders including type 2 diabetes mellitus (T2DM). Bariatric surgery is the most successful therapeutic option that causes sustained weight loss and improvements in obesity comorbidities. Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are two of the most frequently performed bariatric surgeries. Despite their different anatomical rearrangement, they have remarkably similar success in both weight loss and T2DM remission. Interestingly, they also both cause a wide range of endocrine changes. Many of these endocrine changes are reflected specifically within the intestine and are implicated as mechanisms for the metabolic success of surgery. However, while most of the work shows that these hormonal changes are associated with the metabolic changes after surgery, causation has been difficult to ascertain. Here, we review the endocrine changes after RYGB and VSG and explore their mechanistic role in the success of bariatric surgery. Further, we explore important changes in gastrointestinal function and the role of these changes in the increase in postprandial endocrine responses after bariatric surgery. © 2017 American Physiological Society. Compr Physiol 7:783-798, 2017.

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Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Abstract: The intestine adapts differently to RYGB vs VSG. RYGB increases intestinal glucose disposal and VSG delays glucose absorption; both contribute to observed improvements in glycemia.

Cited by 175 publications

References 37 publications

Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery

Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery

Longer-Term Physiological and Metabolic Effects of Gastric Bypass Surgery

Endocrine Function after Bariatric Surgery

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