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Serum Glucagon, Bile Acids, and FGF-19: Metabolic Behavior Patterns After Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy

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Abstract

Background

Metabolic/bariatric surgery is a highly effective treatment for obesity and metabolic diseases. Serum glucagon, bile acids, and FGF-19 are key effectors of various metabolic processes and may play central roles in bariatric surgical outcomes. It is unclear whether these factors behave similarly after Roux-en-Y gastric bypass (RYGB) vs vertical sleeve gastrectomy (VSG).

Methods

Serum glucagon, bile acids (cholic acid [CA], chenodeoxycholic acid [CDCA], deoxycholic acid [DCA]), and FGF-19 were analyzed in samples of fasting blood collected before bariatric surgery, on postoperative days 2 and 10, and at 3- and 6-month follow-up.

Results

From September 2016 to July 2017, patients with obesity underwent RYGB or VSG; 42 patients (RYGB n = 21; VSG n = 21) were included in the analysis. In the RYGB group, glucagon, CA, and CDCA increased continuously after surgery (p = 0.0003, p = 0.0009, p = 0.0001, respectively); after an initial decrease (p = 0.04), DCA increased significantly (p = 0.0386). Serum FGF-19 was unchanged. In the VSG group, glucagon increased on day 2 (p = 0.0080), but decreased over the 6-month study course (p = 0.0025). Primary BAs (CA and CDCA) decreased immediately after surgery (p = 0.0016, p = 0.0091) and then rose (p = 0.0350, p = 0.0350); DCA followed the curve of the primary BAs until it fell off at 6 months (p = 0.0005). VSG group serum FGF-19 trended upward.

Conclusion

RYGB and VSG involve different surgical techniques and final anatomical configurations. Between postoperative day 2 and 6-month follow-up, RYGB and VSG resulted in divergent patterns of change in serum glucagon, bile acids, and FGF-19.

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Acknowledgements

We thank TW McGlennon, McGlennon MotiMetrics, Maiden Rock, WI, USA, for statistical analysis review.

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Authors and Affiliations

  1. Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Cui Yang, Julia Brecht, Christoph Reissfelder, Mirko Otto & Georgi Vassilev

  2. Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany

    Christel Weiß

  3. Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, 54750, USA

    Jane N Buchwald

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  1. Cui Yang
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Correspondence to Georgi Vassilev.

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Ethics Approval

All procedures of the study are ethically compliant and were approved (EK 416092015) by the Institutional Review Board of University Medicine Mannheim, Germany. The study was performed in accord with the ethical standards of the 1964 Declaration of Helsinki and its subsequent amendments.

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Written informed consent was obtained from all study participants.

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The authors declare that they have no conflicts of interest or financial ties to disclose. JN Buchwald received a small grant for manuscript development.

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Key Points

1. In the RYGB group: Glucagon and the primary bile acids CA and CDCA increased continuously after surgery, while the secondary bile acid DCA decreased initially and later significantly increased.

2. In the VSG group: Glucagon increased initially but later decreased. The primary bile acids CA and CDCA, as well as DCA, decreased immediately and showed no significant change thereafter.

3. RYGB and VSG resulted in divergent patterns of change in serum glucagon, bile acids, and FGF-19. The different alterations in bile acid levels following RYGB and VSG have been confirmed by a recent meta-analysis.

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Yang, C., Brecht, J., Weiß, C. et al. Serum Glucagon, Bile Acids, and FGF-19: Metabolic Behavior Patterns After Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy. OBES SURG 31, 4939–4946 (2021). https://doi.org/10.1007/s11695-021-05677-3

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  • DOI: https://doi.org/10.1007/s11695-021-05677-3

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