The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control.
Gastric bypass leads to the remission of type 2 diabetes independently of weight loss. Our hypothesis is that changes in bile flow due to the altered anatomy may partly explain the metabolic outcomes of the operation. We prospectively studied 12 patients undergoing gastric bypass and six patients undergoing gastric banding over a 6-wk period. Plasma fibroblast growth factor (FGF)19, stimulated by bile acid absorption in the terminal ileum, and plasma bile acids were measured. In canine and rodent models, we investigated changes in the gut hormone response after altered bile flow. FGF19 and total plasma bile acids levels increased after gastric bypass compared with no change after gastric banding. In the canine model, both food and bile, on their own, stimulated satiety gut hormone responses. However, when combined, the response was doubled. In rats, drainage of endogenous bile into the terminal ileum was associated with an enhanced satiety gut hormone response, reduced food intake, and lower body weight. In conclusion, after gastric bypass, bile flow is altered, leading to increased plasma bile acids, FGF19, incretin. and satiety gut hormone concentrations. Elucidating the mechanism of action of gastric bypass surgery may lead to novel treatments for type 2 diabetes.
Department of Investigative Medicine, Imperial Weight Centre, Imperial College London, London W6 8RF, United Kingdom.
Dimitri J
DJ
Pournaras
Clare
C
Glicksman
Royce P
RP
Vincent
Shophia
S
Kuganolipava
Jamie
J
Alaghband-Zadeh
David
D
Mahon
Jan H R
JH
Bekker
Mohammad A
MA
Ghatei
Stephen R
SR
Bloom
Julian R F
JR
Walters
Richard
R
Welbourn
Carel W
CW
le Roux
D000328:Adult; D000818:Animals; D001646:Bile / Q000502:physiology*; D001647:Bile Acids and Salts / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein; D002151:Calorimetry; D003924:Diabetes Mellitus, Type 2; D004285:Dogs; D005260:Female; D005346:Fibroblast Growth Factors / Q000097:blood; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D019894:Peptide YY / Q000097:blood; D051381:Rats; D017208:Rats, Wistar; D015431:Weight Loss / Q000502:physiology
D001647:Bile Acids and Salts; D001786:Blood Glucose; D019894:Peptide YY; D005346:Fibroblast Growth Factors; D052216:Glucagon-Like Peptide 1; D002097:C-Reactive Protein