The Role of Bile After Roux-en-Y Gastric Bypass in Promoting Weight Loss and Improving Glycaemic Control
The Role of Bile After Roux-en-Y Gastric Bypass in Promoting Weight Loss and Improving Glycaemic Control
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DOI：
10.1210/en.2011-2145
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发表时间：
2012-08-01
期刊：
影响因子：
4.8
通讯作者：
le Roux, Carel W.
中科院分区：
文献类型：
--
作者：
Pournaras, Dimitri J.;Glicksman, Clare;le Roux, Carel W.
胃旁路手术导致2型糖尿病的缓解，与体重减轻无关。我们的假设是，由于解剖结构的改变，胆汁流量的变化可能部分解释了手术的代谢结果。我们前瞻性研究了12例接受胃旁路术的患者和6例接受胃束带术的患者，为期6周。测定回肠末端胆汁酸吸收刺激的血浆成纤维细胞生长因子（FGF）19和血浆胆汁酸。在犬和啮齿动物模型中，我们研究了胆汁流量改变后肠道激素反应的变化。与胃束带术后无变化相比，胃旁路术后FGF 19和总血浆胆汁酸水平升高。在犬模型中，食物和胆汁本身都会刺激饱腹感肠道激素反应。然而，当两者结合时，反应加倍。在大鼠中，内源性胆汁流入回肠末端与饱腹感肠激素反应增强、摄食量减少和体重减轻相关。总之，胃旁路术后，胆汁流量改变，导致血浆胆汁酸、FGF 19、肠促胰岛素增加。和饱腹感肠道激素浓度。阐明胃旁路手术的作用机制可能会导致2型糖尿病的新治疗方法。（内分泌学153：3613-3619，2012）
Gastric bypass leads to the remission of type 2 diabetes independently of weight loss. Our hypothesis is that changes in bile flow due to the altered anatomy may partly explain the metabolic outcomes of the operation. We prospectively studied 12 patients undergoing gastric bypass and six patients undergoing gastric banding over a 6-wk period. Plasma fibroblast growth factor (FGF)19, stimulated by bile acid absorption in the terminal ileum, and plasma bile acids were measured. In canine and rodent models, we investigated changes in the gut hormone response after altered bile flow. FGF19 and total plasma bile acids levels increased after gastric bypass compared with no change after gastric banding. In the canine model, both food and bile, on their own, stimulated satiety gut hormone responses. However, when combined, the response was doubled. In rats, drainage of endogenous bile into the terminal ileum was associated with an enhanced satiety gut hormone response, reduced food intake, and lower body weight. In conclusion, after gastric bypass, bile flow is altered, leading to increased plasma bile acids, FGF19, incretin. and satiety gut hormone concentrations. Elucidating the mechanism of action of gastric bypass surgery may lead to novel treatments for type 2 diabetes. (Endocrinology 153: 3613-3619, 2012)