Skip to main content

Advertisement

SpringerLink
Log in

Gastric emptying of glucose solution and associated plasma concentrations of GLP-1, GIP, and PYY before and after fundoplication

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study was designed to assess the relationship between gastric emptying of glucose solution and the ensuing plasma concentrations of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and glucose-dependent insulinotropic polypeptide (GIP) in patients having undergone fundoplication for gastroesophageal reflux (GERD).

Subjects and methods

In 10 male patients the emptying of 50% glucose solution was determined scintigraphically and its relationship with plasma glucose, GLP-1, PYY, and GIP concentrations was studied before and 3 months after fundoplication.

Results

In the first 30 min after glucose ingestion, emptying was significantly (p = 0.048) faster after fundoplication than before. Emptying and GLP-1 and GIP correlated: the faster the emptying during the first 30 min the greater the concentrations integrated over that period (p = 0.04; p = 0.01; p = 0.02). Emptying and PYY concentrations were unrelated. In the 120–180 min. period, blood glucose concentrations were lower the faster the emptying in the initial 30 min (p = 0.06) and the entire 50-min recording period (p = 0.03) had been. The GLP-1 concentrations integrated over the first 30 min correlated inversely with the integrated plasma glucose during the third hour after ingestion (p = 0.004).

Conclusions

After fundoplication, gastric emptying may, if accelerated in its initial phases, give rise to greater and earlier increases in plasma glucose, GLP-1, and GIP concentrations and thus to reactive hypoglycemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

Similar content being viewed by others

References

  1. Bae J, Park J, Yang H, Kim J (1998) Nutritional status of gastric cancer patients after total gastrectomy. World J Surg 22:254–261

    Article  CAS  Google Scholar 

  2. Bais JE, Samsom M, Boudesteijn EA, van Rijk PP, Akkermans LM, Gooszen HG (1991) Impact of delayed gastric emptying on the outcome of antireflux surgery. Ann Surg 234:139–146

    Article  Google Scholar 

  3. Collins PJ, Horowitz M, Chatterton BE (1988) Proximal, distal and total stomach emptying of a solid digestible meal in normal subjects. Br J Radiol 61:12–18

    Article  CAS  Google Scholar 

  4. Ekman R, Wahlestedt C, Bottcher G, Sundler F, Hakanson R, Panula P (1986) Peptide YY-like immunoreactivity in the central nervous system of the rat. Regul Pept 16:157–168

    Article  CAS  Google Scholar 

  5. Elliott RM, Morgan LM, Tredger A, Deacon S, Wright J, Marks V (1993) Glucagon-like peptide-1 (7–37) amide and the glucose-dependent insulinotropic polypeptide secretion in response to nutrient ingestion in man: acute postprandial and 24-h secretion patterns. J Endocrinol 138:159–166

    Article  CAS  Google Scholar 

  6. Farrell TM, Richardson WS, Halkar R, Lyon CP, Galloway KD, Waring JP, Smith CD, Hunter JG (2001) Nissen fundoplication improves gastric motility in patients with delayed gastric emptying. Surg Endosc 15:271–274

    Article  CAS  Google Scholar 

  7. Fehmann HC, Göke R, Göke B (1995) Cell and molecular biology of the incretin hormones glucagon-like peptide-I and glucose-dependent insulin releasing polypeptide. Endocr Rev 16:390–410

    Article  CAS  Google Scholar 

  8. Flint A, Raben A, Astrup A, Holst JJ (1998) Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. J Clin Invest 101:515–520

    Article  CAS  Google Scholar 

  9. Gebhard B, Holst JJ, Biegelmayer C, Miholic J (2001) Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome. Dig Dis Sci 46:1915–1923

    Article  CAS  Google Scholar 

  10. Holst JJ, Bersani M (1991) Assays for peptide products of somatostatin gene expression. In Methods in Neurosciences, vol. 5: Neuropeptide Technology, edited by PM Conn. San Diego, CA: Academic Press, pp 322

    Google Scholar 

  11. Imamura M (2002) Effects of surgical manipulation of the intestine on peptide YY and its physiology. Peptides 23:403–407

    Article  CAS  Google Scholar 

  12. Krarup T, Madsbad S, Moody AJ, Regeur L, Faber OK, Holst JJ, Sestoft L (1983) Diminished immunoreactive gastric inhibitory polypeptide response to a meal in newly diagnosed type I (insulin dependent) diabetics. J Clin Endocrinol Metab 56:1306–1312

    Article  CAS  Google Scholar 

  13. le Roux CW, Bloom SR Peptide YY (2005) appetite and food intake. Proc Nutr Soc 64:213–216

    Article  CAS  Google Scholar 

  14. Lindeboom MYA, Vu MK, Ringers J, van Rijn PJJ, Neijenhuis P, Masclee AAM (2003) Function of the proximal stomach after partial versus complete laparoscopic fundoplication. Am J Gastroenterol 98:284–290

    Article  CAS  Google Scholar 

  15. Lukaski HC, Bolonchuk WW, Hall CB, Siders WA (1986) Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 60:1327–1332

    Article  CAS  Google Scholar 

  16. Maddern GJ, Jamieson GG (1985) Fundoplication enhances gastric emptying. Ann Surg 210:296–299

    Article  Google Scholar 

  17. Miholic J, Ørskov C, Holst JJ, Kotzerke J, Meyer HJ (1991) Emptying of the gastric substitute, glucagon-like peptide-1 (GLP-1), and reactive hypoglycemia after total gastrectomy. Dig Dis Sci 36:1361–1370

    Article  CAS  Google Scholar 

  18. Miholic J, Reilmann L, Meyer HJ, Körber H, Kotzerke J, Hecker H (1990) Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy. Gastroenterology 99:923–929

    Article  CAS  Google Scholar 

  19. Naito H, Sasaki I, Matsuno S (1998) Surgical aspects of enteroinsular axis after gastrointestinal surgery with reference to incretin secretion. Pancreas 16:370–378

    Article  CAS  Google Scholar 

  20. Nauck M, Schmidt WE, Ebert R, Strietzel J, Cantor P, Hoffmann G, Creutzfeldt W (1989) Insulinotropic properties of synthetic human gastric inhibitory polypeptide in man: interactions with glucose, phenylalanine, and cholecystokinin 8. J Clin Endocrinol Metab 69:654–662

    Article  CAS  Google Scholar 

  21. Neumayer C, Ciovica R, Gadenstatter M, Erd G, Leidl S, Lehr S, Schwab G (2005) Significant weight loss after laparoscopic Nissen fundoplication. Surg Endosc 19:15–20

    Article  CAS  Google Scholar 

  22. Ørskov C, Rabenhøj L, Wettergren A, Kofod H, Holst JJ (1994) Tissue and plasma concentrations of amidated and glycine-extended glucagon-like peptide-1 in humans. Diabetes 43:535–539

    Article  Google Scholar 

  23. Patriti A, Facchiano E, Sanna A, Gulla N, Donini A (2004) The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery. Obes Surg 14:840–848

    Article  Google Scholar 

  24. Stacher G, Lenglinger J, Bergmann H, Schneider C, Hoffmann M, Wölfl G, Stacher-Janotta G (2000) Gastric emptying—a contributory factor in gastro-oesophageal reflux activity? Gut 47:661–666

    Article  CAS  Google Scholar 

  25. Toft-Nielsen M, Madsbad S, Holst JJ (1998) Exaggerated secretion of glucagon-like peptide-1 (GLP-1) could cause reactive hypoglycaemia. Diabetologia 41:1180–1186

    Article  CAS  Google Scholar 

  26. Vecht J, Masclee AA, Lamers CB (1997) The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment. Scand J Gastroenterol 223(Suppl):21–27

    CAS  Google Scholar 

  27. Viljakka M, Saali K, Koskinen M, Karhumäki L, Kössi J, Luostarinen M, Teerenhovi O, Isolauri J (1999) Antireflux surgery enhances gastric emptying. Arch Surg 134:18–21

    Article  CAS  Google Scholar 

  28. Wettergren A, Petersen H, Orskov C, Christiansen J, Sheikh SP, Holst JJ (1994) Glucagon-like peptide-1 7-36 amide and peptide YY from the L-cell of the ileal mucosa are potent inhibitors of vagally induced gastric acid secretion in man. Scand J Gastroenterol 29:501–505

    Article  CAS  Google Scholar 

  29. Wettergren A, Schjoldager B, Mortensen PE, Myhre J, Christiansen J, Holst JJ (1993) Truncated GLP-1 (proglucagon 78-107-amide) inhibits gastric and pancreatic functions in man. Dig Dis Sci 38:665–673

    Article  CAS  Google Scholar 

  30. Yamashita Y, Toge T, Adrian TE (1997) Gastrointestinal hormone in dumping syndrome and reflux esophagitis after gastric surgery. J Smooth Muscle Res 33:37–48

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Surgery, Medical University of Vienna, Wahringergurtel 18, A-1090, Vienna, Austria

    J. Miholic, M. Mittlböck & G. Stacher

  2. Department of Nuclear Medicine, Medical University of Vienna, Wahringergurtel 18, A-1090, Vienna, Austria

    M. Hoffmann

  3. Department of Medical Physiology, Panum Institute, University of Copenhagen, DK-2200, Copenhagen, Denmark

    J.J. Holst

  4. Psychophysiology Unit at the Department of Surgery, Medical University of Vienna, Wahringergurtel 18, A-1090, Vienna, Austria

    J. Lenglinger

  5. Department of Biomedical Engineering, Medical University of Vienna, Vienna, Austria

    H. Bergmann

Authors
  1. J. Miholic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J.J. Holst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Lenglinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Mittlböck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Bergmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Stacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Miholic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miholic, J., Hoffmann, M., Holst, J. et al. Gastric emptying of glucose solution and associated plasma concentrations of GLP-1, GIP, and PYY before and after fundoplication. Surg Endosc 21, 309–314 (2007). https://doi.org/10.1007/s00464-005-0804-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0804-3

Keywords

Search

Navigation