title: Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test.
abstract: BACKGROUND
  The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined.
  
  
  OBJECTIVE
  The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test.
  
  
  METHODS
  Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h.
  
  
  RESULTS
  No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients.
  
  
  CONCLUSIONS
  Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after surgery. This trial was registered at clinicaltrials.gov as NCT02414893.
authors.affiliation: General Surgery Department, emans@csdm.cat.
authors.forename: Esther
authors.initials: E
authors.lastname: Mans
authors.affiliation: Research Unit, and Center for Biomedical Research Network of Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; and.
authors.forename: Mateu
authors.initials: M
authors.lastname: Serra-Prat
authors.affiliation: Research Unit, and.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Palomera
authors.affiliation: General Surgery Department.
authors.forename: Xavier
authors.initials: X
authors.lastname: Suñol
authors.affiliation: Gastrointestinal Physiology Laboratory, Maresme Health Consortium, Barcelona, Spain; Center for Biomedical Research Network of Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Clavé
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D002766:Cholecystokinin / Q000097:blood; D005215:Fasting; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005746:Gastric Emptying; D005768:Gastrointestinal Hormones / Q000378:metabolism*; D005769:Gastrointestinal Motility; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005947:Glucose / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D006815:Hunger; D007333:Insulin Resistance; D008297:Male; D062407:Meals; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D019518:Postprandial Period; D012527:Satiation
chemical_list: D005768:Gastrointestinal Hormones; D054439:Ghrelin; D052216:Glucagon-Like Peptide 1; D002097:C-Reactive Protein; D002766:Cholecystokinin; D005947:Glucose
keywords: CCK; GLP-1; gastric emptying; gastrointestinal motility; ghrelin; hunger; morbid obesity; satiation; sleeve gastrectomy