The Role of Bile After Roux-en-Y Gastric Bypass in Promoting Weight Loss and Improving Glycaemic Control

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 un...

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Published in:	Endocrinology (Philadelphia) Vol. 153; no. 8; pp. 3613 - 3619
Main Authors:	Pournaras, Dimitri J, Glicksman, Clare, Vincent, Royce P, Kuganolipava, Shophia, Alaghband-Zadeh, Jamie, Mahon, David, Bekker, Jan H.R, Ghatei, Mohammad A, Bloom, Stephen R, Walters, Julian R.F, Welbourn, Richard, le Roux, Carel W
Format:	Journal Article
Language:	English
Published:	Chevy Chase, MD Endocrine Society 01-08-2012 Oxford University Press
Subjects:	Acids Adult Animal models Animals Bile Bile - physiology Bile acids Bile Acids and Salts - blood Biological and medical sciences Blood Glucose - metabolism Body weight C-Reactive Protein Calorimetry Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 Diabetes-Insulin-Glucagon-Gastrointestinal Dogs Female Fibroblast Growth Factors - blood Food intake Fundamental and applied biological sciences. Psychology Gastric Bypass Gastrointestinal surgery Glucagon-Like Peptide 1 - blood Growth factors Humans Ileum Male Middle Aged Peptide YY - blood Plasma Rats Rats, Wistar Remission Satiety Small intestine Vertebrates: endocrinology Weight Weight loss Weight Loss - physiology Biological fluid Stomach Digestive system Bile
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0013-7227 1945-7170
DOI:	10.1210/en.2011-2145