title: Mucosal glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide cell numbers in the super-obese human foregut after gastric bypass.
abstract: BACKGROUND
  Super-obesity, a body mass index>50 kg/m(2), is difficult to treat. Many studies have focused on the anatomic changes of the intestines; the physiologic background is not clearly identified. It is established that Roux-en-Y gastric bypass (RYGB) augments secretion of glucagon-like peptide-1 (GLP-1), peptide tyrosine tyrosine (PYY), and insulin, but other aspects of gut hormone cell function in the alimentary limb are unknown.
  
  
  OBJECTIVE
  To study the effects of laparoscopic RYGB on enteroendocrine cells.
  
  
  METHODS
  University-affiliated, high-volume bariatric surgery center.
  
  
  METHODS
  Eighteen nondiabetic patients were drawn from the present study (NCT 01514799), randomizing between biliopancreatic (BP) limbs of either 60 cm (BP60) or 200 cm (BP200). Demographic characteristics did not differ at baseline or 12 months. Pouch and jejunal biopsies were obtained intraoperatively and using endoscopy at 12 months. Mucosal height and density of hormone-producing cell populations were assessed and mRNA expression measured with real-time polymerase chain reaction.
  
  
  RESULTS
  In perianastomotic jejunum, a 4.9-fold increase in GLP-1 cell density was evident 12 months after RYGB, most pronounced in the BP200-group. The densities of glucose-dependent insulinotropic polypeptide (GIP) cells and PYY immunoreactive cells were doubled after 12 months. GIP mRNA was unaffected, but GLP-1 and PYY mRNA were lower 12 months after RYGB. RYGB had no impact on villi length or density of ghrelin-, cholecystokinin-, neurotensin-, secretin-, or serotonin-producing cells after 12 months. Pouch mucosal height and cell densities of ghrelin-, histamine-, serotonin-, and somatostatin-producing cells remained unaffected by RYGB in both groups.
  
  
  CONCLUSIONS
  RYGB selectively increased the density of incretin-producing cell populations in the jejunum. This may provide anatomic explanation for the observed increased plasma levels of incretins.
authors.affiliation: Aleris Obesity, Lund, Sweden.
authors.forename: Bent J
authors.initials: BJ
authors.lastname: Nergård
authors.affiliation: Lund University Diabetes Centre, Malmö, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lindqvist
authors.affiliation: Aleris Obesity, Lund, Sweden.
authors.forename: Hjörtur G
authors.initials: HG
authors.lastname: Gislason
authors.affiliation: Lund University Diabetes Centre, Malmö, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Groop
authors.affiliation: Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Ekelund
authors.affiliation: Lund University Diabetes Centre, Malmö, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Wierup
authors.affiliation: Aleris Obesity, Lund, Sweden; Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden. Electronic address: jan.hedenbro@med.lu.se.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hedenbro
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002452:Cell Count; D005260:Female; D015390:Gastric Bypass; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism*; D005753:Gastric Mucosa / Q000378:metabolism* / Q000473:pathology; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010446:Peptide Fragments / Q000378:metabolism*; D011184:Postoperative Period; D011379:Prognosis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D010446:Peptide Fragments; C101760:gastric inhibitory polypeptide (1-42); D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1
keywords: Enterohormones; GIP; GLP-1; Gastric bypass; Incretins; Superobesity