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Review
. 2009 Sep;12(5):515-21.
doi: 10.1097/MCO.0b013e32832e1b14.

Endocrine and metabolic response to gastric bypass

Affiliations
Review

Endocrine and metabolic response to gastric bypass

Jabbar Saliba et al. Curr Opin Clin Nutr Metab Care. 2009 Sep.

Abstract

Purpose of review: Diabetes resolves in 80% of individuals undergoing successful Roux-en-Y gastric bypass. Absolute caloric restriction alone resulting from gastric anatomic changes indeed leads to weight loss; however, immediate effects in glycemic control often precede substantial weight loss typically associated with insulin sensitivity. One putative explanation relates to hormonal effects accompanying Roux-en-Y gastric bypass. We reviewed the existing and recent literature to investigate the hormonal changes accompanying Roux-en-Y gastric bypass.

Recent findings: Changes in levels of five candidate enteric hormones have been recently associated with early postoperative glycemic control following Roux-en-Y gastric bypass; the strongest effects are seen with variations in glucagon-like peptide-1, glucose-dependent insulinotropic peptide and ghrelin.

Summary: The unique hybridization of static anatomic restriction and dynamic absorptive bypass lends a duality to the beneficial effects of Roux-en-Y gastric bypass. This duality likely explains the short-term and long-term resolution of diabetes in patients undergoing Roux-en-Y gastric bypass.

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Figures

Figure 1
Figure 1. Anatomic rearrangements of the Roux-en-Y gastric bypass
Architecture of the alimentary tract after surgery. A small gastric pouch (20–30 ml) is connected to the jejunum through a gastrojejunostomy establishing oro-anal continuity. The bypassed stomach, duodenum and early jejunum are connected to the Roux limb providing secretory drainage. The Roux limb is delineated between the gastrojejunostomy and jejunojejunostomy.

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