Gastric emptying of glucose solution and associated plasma concentrations of GLP-1, GIP, and PYY before and after fundoplication.
BACKGROUND
This study was designed to assess the relationship between gastric emptying of glucose solution and the ensuing plasma concentrations of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and glucose-dependent insulinotropic polypeptide (GIP) in patients having undergone fundoplication for gastroesophageal reflux (GERD).


METHODS
In 10 male patients the emptying of 50% glucose solution was determined scintigraphically and its relationship with plasma glucose, GLP-1, PYY, and GIP concentrations was studied before and 3 months after fundoplication.


RESULTS
In the first 30 min after glucose ingestion, emptying was significantly (p = 0.048) faster after fundoplication than before. Emptying and GLP-1 and GIP correlated: the faster the emptying during the first 30 min the greater the concentrations integrated over that period (p = 0.04; p = 0.01; p = 0.02). Emptying and PYY concentrations were unrelated. In the 120-180 min. period, blood glucose concentrations were lower the faster the emptying in the initial 30 min (p = 0.06) and the entire 50-min recording period (p = 0.03) had been. The GLP-1 concentrations integrated over the first 30 min correlated inversely with the integrated plasma glucose during the third hour after ingestion (p = 0.004).


CONCLUSIONS
After fundoplication, gastric emptying may, if accelerated in its initial phases, give rise to greater and earlier increases in plasma glucose, GLP-1, and GIP concentrations and thus to reactive hypoglycemia.
Miholic
J
J
Division of General Surgery, Medical University of Vienna, Wahringergurtel 18, A-1090, Vienna, Austria. johannes.miholic@meduniwien.ac.at
Hoffmann
M
M
Holst
J J
JJ
Lenglinger
J
J
Mittlböck
M
M
Bergmann
H
H
Stacher
G
G
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005746:Gastric Emptying / Q000502:physiology*; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery*; D005768:Gastrointestinal Hormones / Q000097:blood* / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D019894:Peptide YY / Q000097:blood; D011182:Postoperative Care; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D005768:Gastrointestinal Hormones; D019894:Peptide YY; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D005947:Glucose