Abstract
Background
Bariatric surgery is the most effective treatment option for obesity, and gut hormones are implicated in the reduction of appetite and weight after Roux-en-Y gastric bypass. Although there is increasing interest in the gut hormone changes after gastric bypass, the long-term changes have not been fully elucidated.
Methods
Thirty-four participants were studied cross-sectionally at four different time points, pre-operatively (n = 17) and 12 (n = 6), 18 (n = 5) and 24 months (n = 6) after laparoscopic Roux-en-Y gastric bypass. Another group of patients (n = 6) were studied prospectively (18–24 months). All participants were given a standard 400 kcal meal after a 12-h fast, and plasma levels of peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) were correlated with changes in appetite over 3 h using visual analogue scores.
Results
The post-operative groups at 12, 18 and 24 months had a higher post-prandial PYY response compared to pre-operative (p < 0.05). This finding was confirmed in the prospective study at 18 and 24 months. There was a trend for increasing GLP-1 response at 18 and 24 months, but this did not reach statistical significance (p = 0.189) in the prospective study. Satiety was significantly reduced in the post-operative groups at 12, 18 and 24 months compared to pre-operative levels (p < 0.05).
Conclusions
Roux-en-Y gastric bypass causes an enhanced gut hormone response and increased satiety following a meal. This response is sustained over a 24-month period and may partly explain why weight loss is maintained.
Similar content being viewed by others
References
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Vincent RP, le Roux CW. Changes in gut hormones after bariatric surgery. Clin Endocrinol (Oxf). 2008;69:173–9.
le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246:780–5.
Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11:377–82.
Batterham RL, Cohen MA, Ellis SM, et al. Inhibition of food intake in obese subjects by peptide YY3–36. N Engl J Med. 2003;349:941–8.
Savage AP, Adrian TE, Carolan G, et al. Effects of peptide YY (PYY) on mouth to caecum intestinal transit time and on the rate of gastric emptying in healthy volunteers. Gut. 1987;28:166–70.
Kreymann B, Williams G, Ghatei MA, et al. Glucagon-like peptide-1 7–36: a physiological incretin in man. Lancet. 1987;2:1300–4.
Adrian TE, Bloom SR, Bryant MG, et al. Distribution and release of human pancreatic polypeptide. Gut. 1976;17:940–44.
Korner J, Bessler M, Cirilo LJ, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005;90:359–65.
Chan JL, Mun EC, Stoyneva V, et al. Peptide YY levels are elevated after gastric bypass surgery. Obesity (Silver Spring). 2006;14:194–8.
Rodieux F, Giusti V, D’Alessio DA, et al. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008;16:298–305.
Reinehr T, Roth CL, Schernthaner GH, et al. Peptide YY and glucagon-like peptide-1 in morbidly obese patients before and after surgically induced weight loss. Obes Surg. 2007;17:1571–7.
Garcia-Fuentes E, Garrido-Sanchez L, Garcia-Almeida JM, et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels. Obes Surg. 2008;18:1424–9.
Borg CM, le Roux CW, Ghatei MA, et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93:210–5.
Stratis C, Alexandrides T, Vagenas K, et al. Ghrelin and peptide YY levels after a variant of biliopancreatic diversion with Roux-en-Y gastric bypass versus after colectomy: a prospective comparative study. Obes Surg. 2006;16:752–8.
Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.
Morínigo R, Vidal J, Lacy AM, et al. Circulating peptide YY, weight loss, and glucose homeostasis after gastric bypass surgery in morbidly obese subjects. Ann Surg. 2008;247:270–5.
Vidal J, Nicolau J, Romero F, et al. Long-term effects of Roux-en-Y gastric bypass surgery on plasma glp-1 and islet function in morbidly obese subjects. J Clin Endocrinol Metab. 2009;94:884–91.
Laferrere B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.
de Carvalho CP, Marin DM, de Souza AL, et al. GLP-1 and adiponectin: effect of weight loss after dietary restriction and gastric bypass in morbidly obese patients with normal and abnormal glucose metabolism. Obes Surg. 2009;19(3):313–20.
Morínigo R, Lacy AM, Casamitjana R, et al. GLP-1 and changes in glucose tolerance following gastric bypass surgery in morbidly obese subjects. Obes Surg. 2006;16(12):1594–601.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pournaras, D.J., Osborne, A., Hawkins, S.C. et al. The Gut Hormone Response Following Roux-en-Y Gastric Bypass: Cross-sectional and Prospective Study. OBES SURG 20, 56–60 (2010). https://doi.org/10.1007/s11695-009-9989-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-009-9989-1