Potential Role of Bilio-Pancreatic Limb on Clinical Outcomes Following RYGB Bariatric Surgery
Kamran Abolmaali, MD, MRCS, Adam T. Stearns, BMBCH, MRCS, Anita Balakrishnan, BMBS, MRCS, David B. Rhoads, PhD, Stanley W. Ashley, MD, Ali Tavakkolizadeh, MBBS, FRCS
Brigham and Women’s Hospital, Boston, MA
PURPOSE OF STUDY
Although Roux-en-Y gastric bypass (RYGB) results in rapid resolution of type-2 diabetes (T2DM), the mechanism underlying this process are poorly understood. We have shown that RYGB leads to decreased intestinal glucose transport by isolating the recently identified proximal intestine sweet taste receptors, T1R2/3. To see if a critical length of proximal bowl needs to be isolated to alter intestinal glucose absorptive capacity, we designed experiments to stimulate different lengths of proximal bowel with a sweet taste agonist, and study its effect on intestinal glucose absorption.
Rats underwent duodenal cannulation and infusion of 0.3% saccharin (T1R2/3 agonist) or mannitol (control). Duodenum with either the first 3cm of jejunum (Short Limb, SL), or the first 10cm of jejunum (Long Limb, LL) were infused (n=7) (Figure 1). Mid-jejunum (not exposed to the infusate) was harvested and analyzed for SGLT1 expression and function (Figure S1).
SUMMARY OF RESULTS
We demonstrated a significant increase in SGLT1 protein expression with saccharin vs. control in the LL group (p<0.05) (Figure 2). This increase was not seen in the SL arm. Similarly, we did not find any significant difference in glucose transporters, SGLT1 or GLUT2, at brush-border membrane vesicles in SL group.
Although contribution of Roux limb length to clinical outcomes after a RYGB has been studied, few have investigated the contribution of bilio-pancreatic (BP) limb to outcomes. Our studies suggest that isolation of a critical length of proximal bowel is important to alter intestinal glucose absorptive capacity. This underscores the need for clinical studies to evaluate the optimal length of BP limb, especially in T2DM patients.
TABLES AND CHARTS