Entero-Endocrine Changes After Gastric Bypass in Diabetic and Nondiabetic Patients: A Preliminary Study

Bryan A. Whitson, Daniel B. Leslie, Todd A. Kellogg, Michael A. Maddaus, Henry Buchwald, Charles J. Billington, Sayeed Ikramuddin

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73 Scopus citations


Introduction: Alterations in entero-endocrine signaling may play a role in improvements in satiety and glucose tolerance after Roux-en-Y gastric bypass (RYGB). We report our findings of gut hormone secretion in a cohort of diabetic and nondiabetic morbidly obese patients. Materials and methods: Ten morbidly obese subjects who underwent uncomplicated RYGB were studied: 5 were diabetic and 9 were female. Nonfasting plasma levels of glucagon-like peptide-1 (GLP-1), insulin, desacyl ghrelin, active ghrelin, neuropeptide Y (NPY), and gastric inhibitory polypeptide (GIP) were determined preoperatively and 6 months postoperatively. Results: Mean patient age was 42 ± 11 years, and the mean preoperative body mass index was 50 ± 6 kg/m2. At 6 months mean BMI fell to 33 ± 5 kg/m2 (P < 0.0001), and there were no differences between diabetics and nondiabetics with respect to amount of weight loss. In non-diabetics, compared to preoperative levels, there were significant increases in GLP-1 and desacyl-ghrelin in the nondiabetic patients (P = 0.046 and P = 0.016, respectively); no change in plasma insulin, active ghrelin, NPY, or GIP was demonstrated. In contrast, when compared to preoperative levels, there were no significant changes in entero-endocrine hormone levels in the diabetic cohort postoperatively. Conclusions: At 6 months postoperation, RYGB significantly alters the hormone levels for GLP-1 and desacyl-ghrelin in morbidly obese nondiabetic patients. No significant change was noted in a matched cohort of diabetic patients. Weight loss was similar in diabetics and nondiabetics, suggesting that GLP-1 and ghrelin are not the only mechanisms producing weight loss after RYGB.

Original languageEnglish (US)
Pages (from-to)31-39
Number of pages9
JournalJournal of Surgical Research
Issue number1
StatePublished - Jul 2007


  • adipokine
  • diabetic
  • entero-endocrine axis
  • gastric bypass
  • morbid obesity


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