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Mini-Gastric Bypass, Diabetes and Duodenal ExclusionSurgical operations which shorten the intestinal tract between the stomach and the terminal ileum (Like the MGB) result in improvement in type 2 diabetes, and an explanation is the expedited arrival of undigested food in the terminal ileum. This and other studies show that proximal intestinal bypass could be considered for diabetes treatment and that factors from the proximal bowel contribute to the pathophysiology of type 2 diabetes. Pancreatic Peptide YY3-36 is a peptide produced in the small intestine and colon that reduces appetite in response to feeding. Gastric bypass results in a more robust PYY response to caloric intake, which, in conjunction with decreased ghrelin levels, may contribute to the sustained efficacy of this procedure. Studies in gastric bypass patients show that in response to a test meal, there was an increased rise in PYY in gastric bypass patients, (peak PYY concentration 163in gastric bypass patients compared to 58 in controls. The total amount of PYY was significantly greater in bypassed patients as compared with both control groups.
Ann Surg.
2004 Jan;239(1):1-11.
Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease.IRCAD-EITS(European Institue of Telesurgery), Louis Pasteur University, Strasbourg, France. f.rubino@lycos.com BACKGROUND: The Roux-en-Y gastric bypass and the biliopancreatic diversion effectively induce weight loss and long-term control of type 2 diabetes in morbidly obese individuals. It is unknown whether the control of diabetes is a secondary outcome from the treatment of obesity or a direct result of the duodenal-jejunal exclusion that both operations include. The aim of this study was to investigate whether duodenal-jejunal exclusion can control diabetes independently on resolution of obesity-related abnormalities. METHODS: A gastrojejunal bypass (GJB) with preservation of an intact gastric volume was performed in 10- to 12-week-old Goto-Kakizaki rats, a spontaneous nonobese model of type 2 diabetes. Fasting glycemia, oral glucose tolerance, insulin sensitivity, basal plasma insulin, and glucose-dependent-insulinotropic peptide as well as plasma levels of cholesterol, triglycerides, and free fatty acids were measured. The GJB was challenged against a sham operation, marked food restriction, and medical therapy with rosiglitazone in matched groups of animals. Rats were observed for 36 weeks after surgery. RESULTS: Mean plasma glucose 3 weeks after GJB was 96.3 +/- 10.1 mg/dL (preoperative values were 159 +/- 47 mg/dL; P = 0.01). GJB strikingly improved glucose tolerance, inducing a greater than 40% reduction of the area under blood glucose concentration curve (P < 0.001). These effects were not seen in the sham-operated animals despite similar operative time, same postoperative food intake rates, and no significant difference in weight gain profile. GJB resulted also in better glycemic control than greater weight loss from food restriction and than rosiglitazone therapy. CONCLUSIONS: Results of our study support the hypothesis that the bypass of duodenum and jejunum can directly control type 2 diabetes and not secondarily to weight loss or treatment of obesity. These findings suggest a potential role of the proximal gut in the pathogenesis the disease and put forward the possibility of alternative therapeutic approaches for the management of type 2 diabetes. |
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