Entero-Endocrine Changes After Gastric Bypass in Diabetic and Nondiabetic Patients: A Preliminary Study

Whitson, Bryan A.; Leslie, Daniel B.; Kellogg, Todd A.; Maddaus, Michael A.; Buchwald, Henry; Billington, Charles J.; Ikramuddin, Sayeed

doi:10.1016/j.jss.2007.02.022

« Previous Next »Journal of Surgical Research
Volume 141, Issue 1 , Pages 31-39, July 2007

Entero-Endocrine Changes After Gastric Bypass in Diabetic and Nondiabetic Patients: A Preliminary Study

Bryan A. Whitson, M.D.
- Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota
Daniel B. Leslie, M.D.
- Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota
Todd A. Kellogg, M.D.
- Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota
Michael A. Maddaus, M.D.
- Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota
Henry Buchwald, M.D., Ph.D.
- Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota
Charles J. Billington, M.D.
- Department of Medicine, Section of Endocrinology and Metabolism, Center for Diabetes Research, University of Minnesota, Minneapolis, Minnesota
Sayeed Ikramuddin, M.D.
- Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota
- To whom correspondence and reprint requests should be addressed at University of Minnesota Department of Surgery, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455.

Received 8 January 2007

Introduction

Alterations in entero-endocrine signaling may play a role in improvements in satiety and glucose tolerance after Roux-en-Y gastric bypass (RYGB). We report our findings of gut hormone secretion in a cohort of diabetic and nondiabetic morbidly obese patients.

Materials and methods

Ten morbidly obese subjects who underwent uncomplicated RYGB were studied: 5 were diabetic and 9 were female. Nonfasting plasma levels of glucagon-like peptide-1 (GLP-1), insulin, desacyl ghrelin, active ghrelin, neuropeptide Y (NPY), and gastric inhibitory polypeptide (GIP) were determined preoperatively and 6 months postoperatively.

Results

Mean patient age was 42 ± 11 years, and the mean preoperative body mass index was 50 ± 6 kg/m². At 6 months mean BMI fell to 33 ± 5 kg/m² (P < 0.0001), and there were no differences between diabetics and nondiabetics with respect to amount of weight loss. In non-diabetics, compared to preoperative levels, there were significant increases in GLP-1 and desacyl-ghrelin in the nondiabetic patients (P = 0.046 and P = 0.016, respectively); no change in plasma insulin, active ghrelin, NPY, or GIP was demonstrated. In contrast, when compared to preoperative levels, there were no significant changes in entero-endocrine hormone levels in the diabetic cohort postoperatively.

Conclusions

At 6 months postoperation, RYGB significantly alters the hormone levels for GLP-1 and desacyl-ghrelin in morbidly obese nondiabetic patients. No significant change was noted in a matched cohort of diabetic patients. Weight loss was similar in diabetics and nondiabetics, suggesting that GLP-1 and ghrelin are not the only mechanisms producing weight loss after RYGB.

Key Words: morbid obesity, gastric bypass, diabetic, adipokine, entero-endocrine axis