Nutrients handling after bariatric surgery, the role of gastrointestinal adaptation.
Nutrients handling after bariatric surgery, the role of gastrointestinal adaptation.
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DOI：
10.1007/s40519-021-01194-5
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Santini F
中科院分区：
文献类型：
--
作者：
Camastra S;Palumbo M;Santini F
减肥手术决定了胃肠道的重排，影响营养物质的处理，并在手术后观察到的代谢变化中发挥作用。大多数变化取决于Roux-en-Y胃旁路术（RYGB）中观察到的胃排空加速，在较小程度上，袖状胃切除术（SG）。膳食快速输送到空肠，特别是在RYGB后，有助于外周循环中葡萄糖的迅速出现。葡萄糖增加是GLP-1增加的主要决定因素，从而刺激胰岛素分泌，后者通过刺激EGP以预防低血糖的胰高血糖素反常增加来平衡。蛋白质消化和氨基酸吸收在RYGB后出现加速，但SG后没有。RYGB后，肠道对新条件的适应参与了代谢变化。肠道运输延迟，肠道微生物瘤改变，上皮变得肥大，葡萄糖转运蛋白的表达和分泌激素的细胞数量增加。SG后未观察到这些变化。SG-胆汁酸（BA）增加后RYGB-减少，影响葡萄糖代谢，可能调节FXR和TGR 5，影响胰岛素敏感性。肌肉、肝脏和脂肪组织胰岛素敏感性提高，肠道通过增强葡萄糖摄取和BA的作用加强IS的恢复。RYGB后观察到的肠道变化导致脂质轻度吸收不良，但碳水化合物和蛋白质没有吸收不良。总之，RYGB和SG后肠道的功能和形态适应激活器官间串扰，调节手术后观察到的代谢变化。证据等级V级，叙述性文献综述。
Bariatric surgery determines a rearrangement of the gastrointestinal tract that influences nutrient handling and plays a role in the metabolic changes observed after surgery. Most of the changes depend on the accelerated gastric emptying observed in Roux-en-Y gastric bypass (RYGB) and, to a lesser extent, in sleeve gastrectomy (SG). The rapid delivery of meal into the jejunum, particularly after RYGB, contributes to the prompt appearance of glucose in peripheral circulation. Glucose increase is the principal determinant of GLP-1 increase with the consequent stimulation of insulin secretion, the latter balanced by a paradoxical glucagon increase that stimulates EGP to prevent hypoglycaemia. Protein digestion and amino acid absorption appear accelerated after RYGB but not after SG. After RYGB, the adaptation of the gut to the new condition participates to the metabolic change. The intestinal transit is delayed, the gut microbioma is changed, the epithelium becomes hypertrophic and increases the expression of glucose transporter and of the number of cell secreting hormones. These changes are not observed after SG. After RYGB—less after SG—bile acids (BA) increase, influencing glucose metabolism probably modulating FXR and TGR5 with an effect on insulin sensitivity. Muscle, hepatic and adipose tissue insulin sensitivity improve, and the gut reinforces the recovery of IS by enhancing glucose uptake and through the effect of the BA. The intestinal changes observed after RYGB result in a light malabsorption of lipid but not of carbohydrate and protein. In conclusion, functional and morphological adaptations of the gut after RYGB and SG activate inter-organs cross-talk that modulates the metabolic changes observed after surgery. Level of evidence Level V, narrative literature review.
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仅在发生大量体重减轻并与减肥幅度相关后，才能观察到胃旁路手术后的外周葡萄糖吸收的改善。
影响因子：
3.2
作者：
Campos, Guilherme M.;Rabl, Charlotte;Peeva, Sofia;Ciovica, Ruxandra;Rao, Madhu;Schwarz, Jean-Marc;Havel, Peter;Schambelan, Morris;Mulligan, Kathleen
通讯作者：
Mulligan, Kathleen
影响因子：
4.6
作者：
Angelini, Giulia;Gissey, Lidia Castagneto;Casella, Giovanni
通讯作者：
Casella, Giovanni
影响因子：
29
作者：
Baud, Gregory;Daoudi, Mehdi;Pattou, Francois
通讯作者：
Pattou, Francois
糖尿病和非糖尿病肥胖患者的肌肉和脂肪组织形态，胰岛素敏感性和β细胞功能：减肥手术的影响。
影响因子：
4.6
作者：
Camastra S;Vitali A;Anselmino M;Gastaldelli A;Bellini R;Berta R;Severi I;Baldi S;Astiarraga B;Barbatelli G;Cinti S;Ferrannini E
通讯作者：
Ferrannini E
影响因子：
6.9
作者：
Bradley, David;Magkos, Faidon;Eagon, J. Christopher;Varela, J. Esteban;Gastaldelli, Amalia;Okunade, Adewole L.;Patterson, Bruce W.;Klein, Samuel
通讯作者：
Klein, Samuel