Skip to main content

Advertisement

SpringerLink
Log in

Impact of Duodenal-Jejunal Exclusion on Satiety Hormones

  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Objective

Bariatric procedures that exclude the proximal small intestine lead to significant weight loss which is probably mediated by changes in hormones that alter appetite, such as peptide YY (PYY), ghrelin, cholecystokinin (CCK), and leptin. Here, the effect of the non-surgical duodenal-jejunal bypass liner (DJBL) on concentrations of hormones implicated in appetite control was investigated.

Subjects

A two-center prospective study was conducted between January and December 2010. Seventeen obese subjects with type 2 diabetes were treated with the DJBL for 24 weeks. Fasting concentrations of leptin and meal responses of plasma PYY, CCK, and ghrelin were determined prior to and after implantation of the DJBL.

Results

At baseline, subjects had an average body weight of 116.0 ± 5.8 kg. One week after implantation, subjects had lost 4.3 ± 0.6 kg (p < 0.01), which progressed to 12.7 ± 1.3 kg at week 24 (p < 0.01). Postprandial concentrations of PYY and ghrelin increased (baseline vs. week 1 vs. week 24 PYY: 2.6 ± 0.2 vs. 4.1 ± 0.4 vs. 4.1 ± 0.7 nmol/L/min and ghrelin: 7.8 ± 1.8 vs. 11.0 ± 1.8 vs. 10.6 ± 1.8 ng/mL/min, all p < 0.05). In parallel, the CCK response decreased (baseline vs. week 1 vs. week 24: 434 ± 51 vs. 229 ± 52 vs. 256 ± 51pmol/L/min, p < 0.01). Fasting leptin concentrations also decreased (baseline vs. week 24: 98 ± 17 vs. 53 ± 10 ng/mL, p < 0.01).

Conclusions

DJBL treatment induces weight loss paralleled by changes in concentrations of hormones involved in appetite control.

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

Similar content being viewed by others

References

  1. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  PubMed  Google Scholar 

  2. Kaplan LM. Pharmacological therapies for obesity. Gastroenterol Clin North Am. 2005;34(1):91–104.

    Article  PubMed  Google Scholar 

  3. Brolin RE. Bariatric surgery and long-term control of morbid obesity. JAMA. 2002;288(22):2793–6.

    Article  PubMed  Google Scholar 

  4. Borg CM, le Roux CW, Ghatei MA, Bloom SR, Patel AG, Aylwin SJ. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93(2):210–5.

    Article  CAS  PubMed  Google Scholar 

  5. le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.

    Article  PubMed  Google Scholar 

  6. Strader AD, Woods SC. Gastrointestinal hormones and food intake. Gastroenterology. 2005;128(1):175–91.

    Article  CAS  PubMed  Google Scholar 

  7. Wren AM, Bloom SR. Gut hormones and appetite control. Gastroenterology. 2007;132(6):2116–30.

    Article  CAS  PubMed  Google Scholar 

  8. Michalakis K, le Roux C. Gut hormones and leptin: impact on energy control and changes after bariatric surgery—what the future holds. Obes Surg. 2012;22(10):1648–57.

    Article  PubMed  Google Scholar 

  9. Considine RV, Sinha MK, Heiman ML, Kriauciunas A, Stephens TW, Nyce MR, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334(5):292–5.

    Article  CAS  PubMed  Google Scholar 

  10. Zwirska-Korczala K, Konturek SJ, Sodowski M, Wylezol M, Kuka D, Sowa P, et al. Basal and postprandial plasma levels of PYY, ghrelin, cholecystokinin, gastrin and insulin in women with moderate and morbid obesity and metabolic syndrome. J Physiol Pharmacol : Off J Polish Physiol Soc. 2007;58 Suppl 1:13–35.

    Google Scholar 

  11. le Roux CW, Batterham RL, Aylwin SJ, Patterson M, Borg CM, Wynne KJ, et al. Attenuated peptide YY release in obese subjects is associated with reduced satiety. Endocrinology. 2006;147(1):3–8.

    Article  PubMed  Google Scholar 

  12. Tschop M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50(4):707–9.

    Article  CAS  PubMed  Google Scholar 

  13. Cummings DE, Foster KE. Ghrelin-leptin tango in body-weight regulation. Gastroenterology. 2003;124(5):1532–5.

    Article  PubMed  Google Scholar 

  14. Meier U, Gressner AM. Endocrine regulation of energy metabolism: review of pathobiochemical and clinical chemical aspects of leptin, ghrelin, adiponectin, and resistin. Clin Chem. 2004;50(9):1511–25.

    Article  CAS  PubMed  Google Scholar 

  15. le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243(1):108–14.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc. 2010;110(4):571–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41.

    Article  PubMed  Google Scholar 

  18. Ochner CN, Gibson C, Shanik M, Goel V, Geliebter A. Changes in neurohormonal gut peptides following bariatric surgery. Int J Obes. 2011;35(2):153–66.

    Article  CAS  Google Scholar 

  19. Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Tymitz K, Engel A, McDonough S, Hendy MP, Kerlakian G. Changes in ghrelin levels following bariatric surgery: review of the literature. Obes Surg. 2011;21(1):125–30.

    Article  PubMed  Google Scholar 

  21. Korner J, Inabnet W, Febres G, Conwell IM, McMahon DJ, Salas R, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes. 2009;33(7):786–95.

    Article  CAS  Google Scholar 

  22. Escalona A, Pimentel F, Sharp A, Becerra P, Slako M, Turiel D, et al. Weight loss and metabolic improvement in morbidly obese subjects implanted for 1 year with an endoscopic duodenal-jejunal bypass liner. Ann Surg. 2012;255(6):1080–5.

    Article  PubMed  Google Scholar 

  23. Schouten R, Rijs CS, Bouvy ND, Hameeteman W, Koek GH, Janssen IM, et al. A multicenter, randomized efficacy study of the endobarrier gastrointestinal liner for presurgical weight loss prior to bariatric surgery. Ann Surg. 2010;251(2):236–43.

    Article  PubMed  Google Scholar 

  24. de Jonge C, Rensen SS, Verdam FJ, Vincent RP, Bloom SR, Buurman WA, et al. Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes. Obes Surg. 2013;23(9):1354–60.

    Article  PubMed  Google Scholar 

  25. Kreymann B, Williams G, Ghatei MA, Bloom SR. Glucagon-like peptide-1 7–36: a physiological incretin in man. Lancet. 1987;2(8571):1300–4.

    Article  CAS  PubMed  Google Scholar 

  26. van Dielen FM, Buurman WA, Hadfoune M, Nijhuis J, Greve JW. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab. 2004;89(8):4062–8.

    Article  PubMed  Google Scholar 

  27. Miras AD, le Roux CW. Bariatric surgery and taste: novel mechanisms of weight loss. Curr Opin Gastroenterol. 2010;26(2):140–5.

    Article  PubMed  Google Scholar 

  28. Bueter M, le Roux CW. Gastrointestinal hormones, energy balance and bariatric surgery. Int J Obes. 2011;35 Suppl 3:S35–9.

    Article  CAS  Google Scholar 

  29. Cummings DE, Overduin J. Gastrointestinal regulation of food intake. J Clin Invest. 2007;117(1):13–23.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Batterham RL, Cohen MA, Ellis SM, Le Roux CW, Withers DJ, Frost GS, et al. Inhibition of food intake in obese subjects by peptide YY3-36. N Engl J Med. 2003;349(10):941–8.

    Article  CAS  PubMed  Google Scholar 

  31. Huda MS, Wilding JP, Pinkney JH. Gut peptides and the regulation of appetite. Obes Rev. 2006;7(2):163–82.

    Article  CAS  PubMed  Google Scholar 

  32. Cummings DE, Shannon MH. Roles for ghrelin in the regulation of appetite and body weight. Arch Surg. 2003;138(4):389–96.

    Article  CAS  PubMed  Google Scholar 

  33. Sato T, Nakamura Y, Shiimura Y, Ohgusu H, Kangawa K, Kojima M. Structure, regulation and function of ghrelin. J Biochem. 2012;151(2):119–28.

    Article  CAS  PubMed  Google Scholar 

  34. Oswal A, Yeo G. Leptin and the control of body weight: a review of its diverse central targets, signaling mechanisms, and role in the pathogenesis of obesity. Obesity. 2010;18(2):221–9.

    Article  PubMed  Google Scholar 

  35. Maljaars PW, Symersky T, Kee BC, Haddeman E, Peters HP, Masclee AA. Effect of ileal fat perfusion on satiety and hormone release in healthy volunteers. Int J Obes. 2008;32(11):1633–9.

    Article  CAS  Google Scholar 

  36. Maljaars PW, Peters HP, Mela DJ, Masclee AA. Ileal brake: a sensible food target for appetite control. A review. Physiol Behav. 2008;95(3):271–81.

    Article  CAS  PubMed  Google Scholar 

  37. Dockray GJ. Cholecystokinin. Curr Opin Endocrinol Diabetes Obes. 2012;19(1):8–12.

    Article  CAS  PubMed  Google Scholar 

  38. Verhulst PJ, Depoortere I. Ghrelin’s second life: from appetite stimulator to glucose regulator. World J Gastroenterol. 2012;18(25):3183–95.

    PubMed Central  CAS  PubMed  Google Scholar 

  39. Ariyasu H, Takaya K, Tagami T, Ogawa Y, Hosoda K, Akamizu T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86(10):4753–8.

    Article  CAS  PubMed  Google Scholar 

  40. Woods SC, D’Alessio DA. Central control of body weight and appetite. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S37–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122(12):4667–74.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. de Moura EG, Orso IR, Martins Bda C, Lopes GS, de Oliveira SL, Galvao-Neto Mdos P, et al. Improvement of insulin resistance and reduction of cardiovascular risk among obese patients with type 2 diabetes with the duodenojejunal bypass liner. Obes Surg. 2011;21(7):941–7.

    Article  PubMed  Google Scholar 

  43. Evans S, Pamuklar Z, Rosko J, Mahaney P, Jiang N, Park C, et al. Gastric bypass surgery restores meal stimulation of the anorexigenic gut hormones glucagon-like peptide-1 and peptide YY independently of caloric restriction. Surg Endosc. 2012;26(4):1086–94.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the subjects contributing to this trial; the trial nurses Y. Wils and R. Nelissen, and the students who helped conducting this research: G. Latten, N. Geubbels, M. de Wolf, T. van der Horst, R. Erbil, B. van der Putten, H. D’Agnolo, S. Peeters Weem, and M.A. Joosten; B. Winkens for statistical assistance; Dr. R.J. de Ridder, Dr. G.H. Koek, and Dr. C.M. Bakker for their help with the DJBL procedures; Prof. Dr. A.A. Masclee, Dr. J. Maljaars, and Y. Slaats for their help regarding the study design, and Dr. I.C. Arts and E. Theunisz for the Luminex analyses.

Clinical Trial Registration Number: NCT00985114

Conflict of Interest

N.D.B. and J.W.M.G. disclose the following financial relationships relevant to this publication. N.D.B. received an open research grant from GI dynamics. J.W.M.G. received consultancy fees an open research grant and support for travel to meetings for the study or other purposes from GI dynamics. All other authors have no conflicts of interest relevant to this article.

Grant Information

C.J., N.D.B. and J.W.M.G. disclose the following financial relationships relevant to this publication. C.J. received support for travel to meetings for the study or other purposes from GI dynamics. N.D.B. received an open research grant from GI dynamics. J.W.M.G. received consultancy fees an open research grant and support for travel to meetings for the study or other purposes from GI dynamics. All other authors have no conflicts of interest relevant to this work.

Author information

Authors and Affiliations

  1. Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Charlotte de Jonge, Sander S. Rensen, Froukje J. Verdam & Nicole D. Bouvy

  2. Department of General Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands

    Charlotte de Jonge & Jan Willem M. Greve

  3. Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, UK

    Royce P. Vincent

  4. Department of Medicine, Imperial College London, Du Cane Road, W12 0NN, London, UK

    Steve R. Bloom & Carel W. le Roux

  5. School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Wim A. Buurman

  6. Department of Experimental Pathology, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Belfield Dublin 4, Dublin, Ireland

    Carel W. le Roux

  7. Department of General Surgery, Atrium Medical Center Parkstad, PO box 4446, 6401 CX, Heerlen, The Netherlands

    Jan Willem M. Greve

Authors
  1. Charlotte de Jonge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sander S. Rensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Froukje J. Verdam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Royce P. Vincent
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steve R. Bloom
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wim A. Buurman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carel W. le Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicole D. Bouvy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jan Willem M. Greve
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Willem M. Greve.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Jonge, C., Rensen, S.S., Verdam, F.J. et al. Impact of Duodenal-Jejunal Exclusion on Satiety Hormones. OBES SURG 26, 672–678 (2016). https://doi.org/10.1007/s11695-015-1889-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1889-y

Keywords

Search

Navigation