title: Exclusion of the Distal Ileum Cannot Reverse the Anti-Diabetic Effects of Duodenal-Jejunal Bypass Surgery.
abstract: BACKGROUND
  Duodenal-jejunal bypass (DJB) has been proven effective in glycemic control in various type 2 diabetes (T2DM) rat models. "Hindgut hypothesis" and "foregut hypothesis" are two prevailing theories to elucidate the weight-independent anti-diabetic mechanisms of DJB, however, which mechanism plays the dominant role that has not been illuminated.
  
  
  OBJECTIVE
  This paper aims to verify that exclusion of the foregut leads to loss of weight and remission of type 2 diabetes without expedited delivery of nutrients to the distal bowel.
  
  
  METHODS
  Thirty-five diabetic rats induced by high-fat diet (HFD) and low dose of streptozotocin (STZ) were randomly assigned to the control, sham-DJB (S-DJB), DJB, ileal bypass (ILB), and DJB combined with ILB (DJB-ILB) groups. Effects of surgeries on body weight, food intake, blood glucose, glucose-stimulated insulin, and gastrointestinal hormones secretion were evaluated at indicated time points.
  
  
  RESULTS
  Compared to the control and S-DJB groups, the DJB group had significant and sustained glycemic control independent of weight loss. Excluding part of the distal ileum did not reverse the diabetic control that followed DJB surgery. The glucagon-like peptide 1 (GLP-1) and PYY levels were significantly increased after DJB. Although GLP-1 and PYY are mainly secreted by L cells in the distal ileum, excluding part of the ileum did not decrease the levels of GLP-1 and PYY after DJB.
  
  
  CONCLUSIONS
  The beneficial effects of DJB in glycemic control could not be reversed by excluding the distal ileum.
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chai
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.
authors.forename: Guangyong
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.
authors.forename: Shaozhuang
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Han
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China. husanyuan1962@hotmail.com.
authors.forename: Sanyuan
authors.initials: S
authors.lastname: Hu
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China. zhangzongli1966@sina.com.
authors.forename: Zongli
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001786:Blood Glucose; D003921:Diabetes Mellitus, Experimental / Q000097:blood / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000601:surgery*; D004195:Disease Models, Animal; D004386:Duodenum / Q000601:surgery*; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D019894:Peptide YY / Q000097:blood; D051381:Rats; D017208:Rats, Wistar
chemical_list: D001786:Blood Glucose; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1
keywords: Duodenal-jejunal bypass; GLP-1; Insulin resistance; Type 2 diabetes mellitus