Abstract
Background
Roux-en-Y gastric bypass (RYGB) surgery causes profound changes in secretion of gastrointestinal hormones and glucose metabolism. We present a detailed analysis of the early hormone changes after RYGB in response to three different oral test meals designed to provide this information without causing side effects (such as dumping).
Methods
We examined eight obese non-diabetic patients before and within 2 weeks after RYGB. On separate days, oral glucose tolerance tests (25 or 50 g glucose dissolved in 200 mL of water) and a liquid mixed meal test (200 mL 300 kcal) were performed. We measured fasting and postprandial glucose, insulin, C-peptide, glucagon, total and intact glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-2 (GLP-2), peptide YY3-36 (PYY), cholecystokinin (CCK), total and active ghrelin, gastrin, somatostatin, pancreatic polypeptide (PP), amylin, leptin, free fatty acids (FFA), and registered postprandial dumping. Insulin sensitivity was measured by homeostasis model assessment of insulin resistance.
Results
Fasting glucose, insulin, ghrelin, and PYY were significantly decreased and FFA was elevated postoperatively. Insulin sensitivity increased after surgery. The postprandial response increased for C-peptide, GLP-1, GLP-2, PYY, CCK, and glucagon (in response to the mixed meal) and decreased for total and active ghrelin, leptin, and gastrin, but were unchanged for GIP, amylin, PP, and somatostatin after surgery. Dumping symptoms did not differ before and after the operation or between the tests.
Conclusions
Within 2 weeks after RYGB, we found an increase in insulin secretion and insulin sensitivity. Responses of appetite-regulating intestinal hormones changed dramatically, all in the direction of reducing hunger.
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Acknowledgments
The authors are indebted to the patients for their willingness to participate in this study. The authors also appreciate the technical assistance of Alis Andersen and Sussi Polmann (Hvidovre University Hospital, Copenhagen, Denmark), Lene Albak and Sofie Pilgaard (Department of Biomedical Sciences, the Panum Institute, University of Copenhagen, Denmark), Alice Lieth and Rikke Kröncke (Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark), and Gitte Kølander Hansen and Vibeke Nielsen (Novo Nordisk, Måløv, Denmark).
Conflicts of Interest
BSW and TRC are employed at Novo Nordisk and NBJ and SHJ are receiving funds to cover one third of their scholarships from Novo Nordisk. No other potential conflicts of interest relevant to this article were declared by any of the authors: SHJ, SCO, CD, NBJ, KNB, UK, DW, TA, LSN, LEH, JFR, BSW, TRC, DLH, JJH, and SM.
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Jacobsen, S.H., Olesen, S.C., Dirksen, C. et al. Changes in Gastrointestinal Hormone Responses, Insulin Sensitivity, and Beta-Cell Function Within 2 Weeks After Gastric Bypass in Non-diabetic Subjects. OBES SURG 22, 1084–1096 (2012). https://doi.org/10.1007/s11695-012-0621-4
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DOI: https://doi.org/10.1007/s11695-012-0621-4