Ponnie Robertlee Dolo

Background Reduced appetite and loss of preference to nutrition dense high-fat diet are present after bariatric surgery. But the mechanism responsible for these changes in biological activities remains unclear. Similar changes in biological activities have been observed with growth/differentiation factor-15/macrophage-inhibitory cytokine-1 (GDF-15/MIC-1) treatment alone. Aim of study To assess the effect of bariatric surgery on GDF-15/MIC-1expression and circulating level in rodent model. Setting The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221,006, P. R. China. Methods Among 40 fatty Sprague–dawley (SD) rats, 30 randomly receive low-dose STZ to induced diabetes and were randomly assigned to Roux en Y gastric bypass (RYGB, n = 10), Sleeve gastrectomy (SG, n = 10), and SHAM (n = 10). The remaining fatty SD rats were assigned to Normal control (NC, n = 10). Rats were followed for 8 weeks postoperatively. Circulating levels of GDF15 and tissue (gastrointestinal and liver) expression were assessed after surgery. Preoperative oral glucose tolerance test (OGTT), and Insulin tolerance test (ITT) were reassessed postoperatively. Changes in bodyweight and food intake were also recorded. Results Bariatric surgery significantly increased circulating plasma level of GDF15 (p < 0.05). Postoperatively, tissue expression of GDF15 was significantly higher in the stomach pouch, jejunum, and ileum of rats in the RYGB group as well as ileum of rats in the SG group compared to Sham and NC (p < 0.05). Higher Expression of GDF15 in the stomach pouch of the SG group was not statistically significant compared to the stomach of Sham and NC group. GDF15 expression in the liver was significantly less in the RYGB group (p < 0.05). Conclusion Bariatric surgery significantly increases circulating levels and gastrointestinal tissue expression of GDF15. Given that GDF15 is an important regulator of energy homeostasis, further studies are needed to ascertain the relevance in bariatric surgery.

Excluding the foregut (distal stomach and duodenum) from food transit in RYGB normalizes glucose tolerance. Excluding/removing the duodenal mucosa partly improves glycemic control. So far, the effect of excluding/removing the gastric mucosa remains unknown.

Gastric bypass with a proximal gastric pouch (Roux-en-Y gastric bypass) induces early diabetes remission. The effect of gastric bypass with a distal gastric pouch remains unknown.

Background Possible mechanisms underlying diabetes remission following Roux-en-Y gastric bypass (RYGB) include eradication of putative factor(s) with duodenal-jejunal bypass. Objective The objective of this study is to observe the effects of duodenal-jejunal transit on glucose tolerance and diabetes remission in gastric bypass rat model. Method In order to verify the effect of duodenal-jejunal transit on glucose tolerance and diabetes remission in gastric bypass, 22 type 2 diabetes Sprague-Dawley rat models established through high-fat diet and low-dose streptozotocin (STZ) administered intraperitoneally were assigned to one of three groups: gastric bypass with duodenal-jejunal transit (GB-DJT n = 8), gastric bypass without duodenal-jejunal transit (RYGB n = 8), and sham (n = 6). Body weight, food intake, blood glucose, as well as meal-stimulated insulin, and incretin hormone responses were assessed to ascertain the effect of surgery in all groups. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were conducted three and 7 weeks after surgery. Results Comparing our GB-DJT to the RYGB group, we saw no differences in the mean decline in body weight, food intake, and blood glucose 8 weeks after surgery. GB-DJT group exhibited immediate and sustained glucose control throughout the study. Glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP) levels were also significantly increased from preoperative level in the GB-DJT group (p < 0.05). Insulin and GLP-1 area under curve (AUC) as well as improved glycemic excursion on OGTT did not differ between GB-DJT and RYGB groups. Outcomes with sham operation did not differ from preoperative level. Conclusion Preserving duodenal-jejunal transit does not impede glucose tolerance and diabetes remission after gastric bypass in type-2 diabetes Sprague-Dawley rat model.