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Exclusion of the Distal Ileum Cannot Reverse the Anti-Diabetic Effects of Duodenal-Jejunal Bypass Surgery

Obesity Surgery volume 26, pages 261–268 (2016)Cite this article

Abstract

Background

Duodenal-jejunal bypass (DJB) has been proven effective in glycemic control in various type 2 diabetes (T2DM) rat models. “Hindgut hypothesis” and “foregut hypothesis” are two prevailing theories to elucidate the weight-independent anti-diabetic mechanisms of DJB, however, which mechanism plays the dominant role that has not been illuminated.

Objective

This paper aims to verify that exclusion of the foregut leads to loss of weight and remission of type 2 diabetes without expedited delivery of nutrients to the distal bowel.

Methods

Thirty-five diabetic rats induced by high-fat diet (HFD) and low dose of streptozotocin (STZ) were randomly assigned to the control, sham-DJB (S-DJB), DJB, ileal bypass (ILB), and DJB combined with ILB (DJB-ILB) groups. Effects of surgeries on body weight, food intake, blood glucose, glucose-stimulated insulin, and gastrointestinal hormones secretion were evaluated at indicated time points.

Results

Compared to the control and S-DJB groups, the DJB group had significant and sustained glycemic control independent of weight loss. Excluding part of the distal ileum did not reverse the diabetic control that followed DJB surgery. The glucagon-like peptide 1 (GLP-1) and PYY levels were significantly increased after DJB. Although GLP-1 and PYY are mainly secreted by L cells in the distal ileum, excluding part of the ileum did not decrease the levels of GLP-1 and PYY after DJB.

Conclusions

The beneficial effects of DJB in glycemic control could not be reversed by excluding the distal ileum.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (no. 81270888/H0713, no. 81370496/H0308, no. 81300286/H0308, no. 81471019/H0712), and the Natural Science Foundation of Shandong Province grants (no. ZR2012HQ030).

Conflict of Interest

The authors declare that they have no competing interests.

Statement of Informed Consent

Informed consent does not apply in this study.

Compliance with Ethical Standards

All applicable institutional and national guidelines for the care and use of animals were followed.

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    Affiliations

    1. Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People’s Republic of China

      Jie Chai, Guangyong Zhang, Shaozhuang Liu, Chunxiao Hu, Haifeng Han, Sanyuan Hu & Zongli Zhang

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    1. Jie Chai
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    2. Guangyong Zhang
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    3. Shaozhuang Liu
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    Correspondence to Sanyuan Hu or Zongli Zhang.

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    Sanyuan Hu and Zongli Zhang contributed equally to this work.

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    Chai, J., Zhang, G., Liu, S. et al. Exclusion of the Distal Ileum Cannot Reverse the Anti-Diabetic Effects of Duodenal-Jejunal Bypass Surgery. OBES SURG 26, 261–268 (2016). https://doi.org/10.1007/s11695-015-1745-0

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    Keywords

    • Duodenal-jejunal bypass
    • Type 2 diabetes mellitus
    • GLP-1
    • Insulin resistance