Physiological adaptations following Roux-en-Y gastric bypass and the identification of targets for bariatric mimetic pharmacotherapy.
The present opinion article provides an overview of the key improvements in metabolic and cardiovascular health following Roux-en-Y Gastric Bypass (RYGB). Some clinically important long-term complications of RYGB are also briefly described to contextualise the potential value of finding selective non-surgical means of replicating only the beneficial aspects of RYGB. Three biological responses linked to changes in gastrointestinal tract structure and function post-RYGB, that are implicated in the clinical efficacy of RYGB and that have actual or potential applications as non-surgical mimetic based approaches are addressed. These are (1) exaggerated post-prandial gut hormone responses; (2) local increases in undiluted bile in the gut lumen and augmented circulating bile acid and FGF19 concentrations and (3) compositional changes in the gut microbiota.
Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Ireland. Electronic address: neil.docherty@ucd.ie.
Neil G
NG
Docherty
Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Ireland; Gastrosurgical Laboratory, University of Gothenburg, Sweden; Investigative Science, Imperial College, London, UK.
Carel W
CW
Le Roux
D000222:Adaptation, Physiological / Q000187:drug effects* / Q000502:physiology; D001647:Bile Acids and Salts / Q000097:blood / Q000378:metabolism; D005346:Fibroblast Growth Factors / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D015390:Gastric Bypass / Q000009:adverse effects; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism* / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000601:surgery; D010446:Peptide Fragments / Q000494:pharmacology / Q000627:therapeutic use*; D019894:Peptide YY / Q000494:pharmacology / Q000627:therapeutic use*; D019518:Postprandial Period / Q000187:drug effects
D001647:Bile Acids and Salts; D010446:Peptide Fragments; D019894:Peptide YY; C061785:peptide YY (3-36); D005346:Fibroblast Growth Factors; D052216:Glucagon-Like Peptide 1