Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1990 Jun;211(6):763–771. doi: 10.1097/00000658-199006000-00016

Gastrointestinal hormone responses to meals before and after gastric bypass and vertical banded gastroplasty.

J M Kellum 1, J F Kuemmerle 1, T M O'Dorisio 1, P Rayford 1, D Martin 1, K Engle 1, L Wolf 1, H J Sugerman 1
PMCID: PMC1358133  PMID: 2192696

Abstract

The purpose of the study was to examine the gastrointestinal hormone responses to meals in morbidly obese patients before and after Roux-en-Y gastric bypass (GBP; n = 9) or vertical banded gastroplasty (VBG; n = 7). On consecutive days before and after operation, we measured changes in peripheral blood levels of glucose, insulin, enteroglucagon, serotonin, vasoactive intestinal polypeptide (VIP), and cholecystokinin (CCK) in response to a standardized glucose or protein-fat meal. The percentage of excess weight lost at 6 months after operation was 66.3% +/- 4% and 41.8% +/- 5% for GBP and VBG, respectively (p less than 0.01). The 3-hour integrated glucose response to a glucose meal decreased from 145.3 +/- 33.7 to 75.8 +/- 15.7 g min/L (p less than 0.02) after GBP. This was associated with a decrease in 3-hour integrated insulin response from 22.8 +/- 8.2 to 10.5 +/- 4.9 mU min/L. Vertical banded gastroplasty patients had lesser reductions of hyperglycemia and hyperinsulinemia. Neither the CCK, serotonin, nor VIP responses to meals were altered by either operation. The 3-hour integrated enteroglucagon response to glucose increased markedly in GBP patients after operation from 11.8 +/- 6 to 133.4 +/- 38 nmol min/mL (p less than 0.02). This increase in enteroglucagon occurred at the same time as development of dumping symptoms, which occurred exclusively in GBP patients after glucose but not protein. We conclude that (1) GBP surgery for morbid obesity results in amelioration of glucose intolerance and hyperinsulinemia, (2) CCK does not mediate an endocrine satiety effect of surgery, (3) GBP is associated with an exaggerated enteroglucagon response to glucose, and (4) enteroglucagon appears to be a marker of the dumping syndrome in GBP patients.

Full text

PDF
763

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bataille D., Gespach C., Coudray A. M., Rosselin G. "Enterolglucagon': a specific effect on gastric glands isolated from the rat fundus. Evidence for an "oxyntomodulin' action. Biosci Rep. 1981 Feb;1(2):151–155. doi: 10.1007/BF01117012. [DOI] [PubMed] [Google Scholar]
  2. Bloom S. R. An enteroglucagon tumour. Gut. 1972 Jul;13(7):520–523. doi: 10.1136/gut.13.7.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Knapp T. R. A methodological critique of the 'ideal weight' concept. JAMA. 1983 Jul 22;250(4):506–510. [PubMed] [Google Scholar]
  4. Kotake C., Heffner T., Vosmer G., Seiden L. Determination of dopamine, norepinephrine, serotonin and their major metabolic products in rat brain by reverse-phase ion-pair high performance liquid chromatography with electrochemical detection. Pharmacol Biochem Behav. 1985 Jan;22(1):85–89. doi: 10.1016/0091-3057(85)90490-3. [DOI] [PubMed] [Google Scholar]
  5. Lawaetz O., Blackburn A. M., Bloom S. R., Aritas Y., Ralphs D. N. Gut hormone profile and gastric emptying in the dumping syndrome. A hypothesis concerning the pathogenesis. Scand J Gastroenterol. 1983 Jan;18(1):73–80. doi: 10.3109/00365528309181562. [DOI] [PubMed] [Google Scholar]
  6. Maton P. N., O'Dorisio T. M., Howe B. A., McArthur K. E., Howard J. M., Cherner J. A., Malarkey T. B., Collen M. J., Gardner J. D., Jensen R. T. Effect of a long-acting somatostatin analogue (SMS 201-995) in a patient with pancreatic cholera. N Engl J Med. 1985 Jan 3;312(1):17–21. doi: 10.1056/NEJM198501033120104. [DOI] [PubMed] [Google Scholar]
  7. Meryn S., Stein D., Straus E. W. Pancreatic polypeptide, pancreatic glucagon and enteroglucagon in morbid obesity and following gastric bypass operation. Int J Obes. 1986;10(1):37–42. [PubMed] [Google Scholar]
  8. Osei K., Falko J. M., O'Dorisio T. M., Adam D. R. Decreased serum C-peptide/insulin molar ratios after oral glucose ingestion in hyperthyroid patients. Diabetes Care. 1984 Sep-Oct;7(5):471–475. doi: 10.2337/diacare.7.5.471. [DOI] [PubMed] [Google Scholar]
  9. PESKIN G. W., MILLER L. D. The role of serotonin in the "dumping syndrome". Arch Surg. 1962 Nov;85:701–704. doi: 10.1001/archsurg.1962.01310050003001. [DOI] [PubMed] [Google Scholar]
  10. Pappas T. N., Melendez R. L., Strah K. M., Debas H. T. Cholecystokinin is not a peripheral satiety signal in the dog. Am J Physiol. 1985 Dec;249(6 Pt 1):G733–G738. doi: 10.1152/ajpgi.1985.249.6.G733. [DOI] [PubMed] [Google Scholar]
  11. Pories W. J., Caro J. F., Flickinger E. G., Meelheim H. D., Swanson M. S. The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. Ann Surg. 1987 Sep;206(3):316–323. doi: 10.1097/00000658-198709000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Rehfeld J. F., Juhl E., Quaade F. Effect of jejunoileostomy on glucose and insulin metabolism in ten obese patients. Metabolism. 1970 Jul;19(7):529–538. doi: 10.1016/0026-0495(70)90008-9. [DOI] [PubMed] [Google Scholar]
  13. Sagor G. R., Bryant M. G., Ghatei M. A., Kirk R. M., Bloom S. R. Release of vasoactive intestinal peptide in the dumping syndrome. Br Med J (Clin Res Ed) 1981 Feb 14;282(6263):507–510. doi: 10.1136/bmj.282.6263.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Santiago J. V., Haymond M. W., Clarke W. L., Pagliara A. S. Glucagon, insulin and glucose response to physiologic testing in normal and massively obese adults. Metabolism. 1977 Oct;26(10):1115–1122. doi: 10.1016/0026-0495(77)90038-5. [DOI] [PubMed] [Google Scholar]
  15. Sirinek K. R., O'Dorisio T. M., Hill D., McFee A. S. Hyperinsulinism, glucose-dependent insulinotropic polypeptide, and the enteroinsular axis in morbidly obese patients before and after gastric bypass. Surgery. 1986 Oct;100(4):781–787. [PubMed] [Google Scholar]
  16. Sirinek K. R., O'Dorisio T. M., Howe B., McFee A. S. Neurotensin, vasoactive intestinal peptide, and Roux-en-Y gastrojejunostomy. Their role in the dumping syndrome. Arch Surg. 1985 May;120(5):605–609. doi: 10.1001/archsurg.1985.01390290083014. [DOI] [PubMed] [Google Scholar]
  17. Sugerman H. J., Londrey G. L., Kellum J. M., Wolf L., Liszka T., Engle K. M., Birkenhauer R., Starkey J. V. Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignment. Am J Surg. 1989 Jan;157(1):93–102. doi: 10.1016/0002-9610(89)90427-3. [DOI] [PubMed] [Google Scholar]
  18. Sugerman H. J., Starkey J. V., Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987 Jun;205(6):613–624. doi: 10.1097/00000658-198706000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Villar H. V., Wangenteen S. L., Burks T. F., Patton D. D. Mechanisms of satiety and gastric emptying after gastric partitioning and bypass. Surgery. 1981 Aug;90(2):229–236. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES