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Gastroenterology. 2016 Feb;150(2):454-64.e9. doi: 10.1053/j.gastro.2015.10.009. Epub 2015 Oct 23.

Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.

Author information

1
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France.
2
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France; Department of Pathology, Bichat Hospital, Paris, France.
3
Department of Nuclear Medicine, Bichat Hospital, Paris, France.
4
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France; Department of General and Digestive Surgery, Bichat Hospital, Paris, France.
5
Department of Pathology, Bichat Hospital, Paris, France.
6
Department of General and Digestive Surgery, Bichat Hospital, Paris, France.
7
Functional Coprology Service, Pitié Salpétrière Hospital Group, Paris, France.
8
INSERM U1149, DHU Unity, Paris Diderot University, Paris, France. Electronic address: maude.le-gall@inserm.fr.

Abstract

BACKGROUND & AIMS:

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.

KEYWORDS:

Enteroendocrine Cells; Enterohormones; GIP; Intestinal Adaptation

PMID:
26481855
DOI:
10.1053/j.gastro.2015.10.009
[Indexed for MEDLINE]
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