Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.
OBJECTIVE
Bariatric procedures, such as Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), are the most effective approaches to resolve type 2 diabetes in obese individuals. Alimentary glucose absorption and intestinal disposal of blood glucose have not been directly compared between individuals or animals that underwent RYGB vs VSG. We evaluated in rats and humans how the gut epithelium adapts after surgery and the consequences on alimentary glucose absorption and intestinal disposal of blood glucose.


METHODS
Obese male rats underwent RYGB, VSG, or sham (control) operations. We collected intestine segments from all rats; we performed histologic analyses and measured levels of messenger RNAs encoding the sugar transporters SGLT1, GLUT1, GLUT2, GLUT3, GLUT4, and GLUT5. Glucose transport and consumption were assayed using ex vivo jejunal loops. Histologic analyses were also performed on Roux limb sections from patients who underwent RYGB 1-5 years after surgery. Roux limb glucose consumption was assayed after surgery by positron emission and computed tomography imaging.


RESULTS
In rats and humans that underwent RYGB, the Roux limb became hyperplasic, with an increased number of incretin-producing cells compared with the corresponding jejunal segment of controls. Furthermore, expression of sugar transporters and hypoxia-related genes increased and the nonintestinal glucose transporter GLUT1 appeared at the basolateral membrane of enterocytes. Ingested and circulating glucose was trapped within the intestinal epithelial cells of rats and humans that underwent RYGB. By contrast, there was no hyperplasia of the intestine after VSG, but the intestinal absorption of alimentary glucose was reduced and density of endocrine cells secreting glucagon-like peptide-1 increased.


CONCLUSIONS
The intestine adapts differently to RYGB vs VSG. RYGB increases intestinal glucose disposal and VSG delays glucose absorption; both contribute to observed improvements in glycemia.
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
Jean-Baptiste
JB
Cavin
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France; Department of Pathology, Bichat Hospital, Paris, France.
Anne
A
Couvelard
Department of Nuclear Medicine, Bichat Hospital, Paris, France.
Rachida
R
Lebtahi
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
Robert
R
Ducroc
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France; Department of General and Digestive Surgery, Bichat Hospital, Paris, France.
Konstantinos
K
Arapis
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
Eglantine
E
Voitellier
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
Françoise
F
Cluzeaud
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
Laura
L
Gillard
Department of Pathology, Bichat Hospital, Paris, France.
Muriel
M
Hourseau
Department of Nuclear Medicine, Bichat Hospital, Paris, France.
Nidaa
N
Mikail
Department of General and Digestive Surgery, Bichat Hospital, Paris, France.
Lara
L
Ribeiro-Parenti
Functional Coprology Service, Pitié Salpétrière Hospital Group, Paris, France.
Nathalie
N
Kapel
Department of General and Digestive Surgery, Bichat Hospital, Paris, France.
Jean-Pierre
JP
Marmuse
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
André
A
Bado
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France. Electronic address: maude.le-gall@inserm.fr.
Maude
M
Le Gall
D000222:Adaptation, Physiological; D000328:Adult; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism*; D004195:Disease Models, Animal; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D051246:Glucose Transport Proteins, Facilitative / Q000235:genetics / Q000378:metabolism; D006801:Humans; D006965:Hyperplasia; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000473:pathology; D007583:Jejunum / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D049268:Positron-Emission Tomography; D012333:RNA, Messenger / Q000378:metabolism; D051381:Rats; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D001786:Blood Glucose; D051246:Glucose Transport Proteins, Facilitative; D012333:RNA, Messenger; D052216:Glucagon-Like Peptide 1
Enteroendocrine Cells; Enterohormones; GIP; Intestinal Adaptation