Effects on GLP-1, PYY, and leptin by direct stimulation of terminal ileum and cecum in humans: Implications for ileal transposition

Henry Buchwald, Robert B. Dorman, Nikolaus F. Rasmus, Van N. Michalek, Nichol M. Landvik, Sayeed Ikramuddin

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Background: We do not have a unified, scientifically tested theory of causation for obesity and its co-morbidities, nor do we have explanations for the mechanics of the metabolic/bariatric surgery procedures. Integral to proffered hypotheses are the actions of the hormones glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and leptin. The objective of this study was to obtain blood levels of GLP-1, PYY, and leptin after stimulation of the terminal ileum and cecum by a static infusion of a food hydrolysate in morbidly obese patients undergoing a duodenal switch procedure. Setting: University Hospital. Methods: Plasma levels of GLP-1, PYY, and leptin were obtained at 0, 30, 60, 90, and 120 minutes after instillation of 240 mL of a food hydrolysate into the ileum or cecum. Results: The mean ± SD GLP-1 values by cecal stimulation for 0, 30, 60, 90, and 120 minutes were: 41.3 ± 23.2; 39.6 ± 21.8; 38.9 ± 19.1; 47.4 ± 22.3; 51.7 ± 27.3 pM, and by ileal stimulation: 55.0 ± 32.8; 83.4 ± 16.1; 78.7 ± 23.8; 84.7 ± 23.5; 76.4 ± 25.6. The mean ± SD PYY values by cecal stimulation were: 62.1 ± 24.8; 91.1 ± 32.8; 102.1 ± 39.6; 119.6 ± 37.5; 130.3 ± 36.7, and by ileal stimulation: 73.8 ± 41.6; 138.1 ± 17.7; 149.5 ± 23.3; 165.7 ± 24.3; 155.5 ± 29.1. Percent change in PYY levels increased ∼ 150%, GLP-1 increased ∼ 50%, and leptin decreased ∼ 20%. Conclusion: Direct stimulation of the human terminal ileum and cecum by a food hydrolysate elicits significant plasma GLP-1 and PYY elevations and leptin decreases, peaking at 90-120 minutes. The ileal GLP-1 and PYY responses exceed those of the cecum, and the PYY effect is about 3-fold that of GLP-1. The results of this study question the satiety premise for ileal transposition.

Original languageEnglish (US)
Pages (from-to)780-786
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume10
Issue number5
DOIs
StatePublished - 2014

Keywords

  • Duodenal switch
  • GLP-1
  • Leptin
  • PYY

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