Abstract
Bariatric surgery is an effective intervention for management of obesity through treating dysregulated appetite and achieving long-term weight loss maintenance. Moreover, significant changes in glucose homeostasis are observed after bariatric surgery including, in some cases, type 2 diabetes remission from the early postoperative period and postprandial hypoglycaemia. Levels of a number of gut hormones are dramatically increased from the early period after Roux-en-Y gastric bypass and sleeve gastrectomy—the two most commonly performed bariatric procedures—and they have been suggested as important mediators of the observed changes in eating behaviour and glucose homeostasis postoperatively. In this review, we summarise the current evidence from human studies on the alterations of gut hormones after bariatric surgery and their impact on clinical outcomes postoperatively. Studies which assess the role of gut hormones after bariatric surgery on food intake, hunger, satiety and glucose homeostasis through octreotide use (a non-specific inhibitor of gut hormone secretion) as well as with exendin 9–39 (a specific glucagon-like peptide-1 receptor antagonist) are reviewed. The potential use of gut hormones as biomarkers of successful outcomes of bariatric surgery is also evaluated.
Highlights
Obesity is a complex, chronic, progressive and relapsing disease which affects currently approximately 650 million adults worldwide [1,2]
The focus for the sections exploring the role of gut hormones as mediators of weight loss and glycaemic outcomes after bariatric surgery will be on studies using either octreotide or exendin 9–39 (Ex-9, a specific glucagon-like peptide-1 (GLP-1) antagonist)
Exaggerated GLP-1 responses after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are probably insufficient in individuals with poor functional capacity of beta cells to secrete enough insulin and to achieve important improvement in postprandial glucose levels postoperatively [153,154]. Another limitation of studies assessing the impact of Ex-9 on glucose homeostasis after bariatric surgery is the small number of participants and the results should be interpreted with caution
Summary
Chronic, progressive and relapsing disease which affects currently approximately 650 million adults worldwide [1,2]. The changes in satiety are profound from the early postoperative period after RYGB and SG and, in some cases, there are alterations in food preferences after these procedures [23,24] These findings are different to what is observed after low-calorie diet, which can be very effective in the induction of weight loss, the vast majority of people fail to maintain the achieved weight loss in the long-term [6,7,25,26]. RYGB and SG lead to increased postprandial secretion of satiety hormones including glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and oxyntomodulin (OXM) [23,32,33,34] These changes in gut hormone secretion from the early period after. The focus for the sections exploring the role of gut hormones as mediators of weight loss and glycaemic outcomes after bariatric surgery will be on studies using either octreotide (a nonspecific inhibitor of gut hormones secretion) or exendin 9–39 (Ex-9, a specific GLP-1 antagonist)
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