TY - JOUR
T1 - Effects of gastrogastric fistula repair on weight loss and gut hormone levels
AU - O'Brien, Ciaran S.
AU - Wang, Gary
AU - McGinty, James
AU - Agénor, Keesandra K.
AU - Dutia, Roxanne
AU - Colarusso, Antonia
AU - Park, Koji
AU - Koshy, Ninan
AU - Laferrère, Blandine
N1 - Funding Information:
Acknowledgments We thank our participants, the technicians from the NYONRC Hormonal core laboratory, Yim Dam and Ping Zhou, Dr. Julio Teixeira for referring patients, and the GCRC-CTSA staff. The study was supported by grants from the St Luke’s–Roosevelt Hospital Pilot Research Program, the American Diabetes Association (CR-7-05 CR-18), the National Institutes of Health (R01-DK067561, P30-DK026687, P30-DK063068), and Columbia University's CTSA grant No. UL1 RR024156 from NCRR/NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the "old route" rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair. Materials and Methods: Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0-120 min for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels. Results: Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY 3-36 levels were no longer lower than the post-GBP group. Conclusions: These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.
AB - Background: Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the "old route" rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair. Materials and Methods: Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0-120 min for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels. Results: Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY 3-36 levels were no longer lower than the post-GBP group. Conclusions: These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.
KW - GLP-1
KW - Gastric bypass
KW - Gastrogastric fistula
KW - Ghrelin
KW - PYY
KW - Weight loss
UR - http://www.scopus.com/inward/record.url?scp=84879968608&partnerID=8YFLogxK
U2 - 10.1007/s11695-013-0917-z
DO - 10.1007/s11695-013-0917-z
M3 - Article
C2 - 23549962
AN - SCOPUS:84879968608
SN - 0960-8923
VL - 23
SP - 1294
EP - 1301
JO - Obesity Surgery
JF - Obesity Surgery
IS - 8
ER -