scholarly journals GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?

2013 ◽  
Vol 169 (6) ◽  
pp. 885-889 ◽  
Author(s):  
Niclas Abrahamsson ◽  
Britt Edén Engström ◽  
Magnus Sundbom ◽  
F Anders Karlsson
Keyword(s):  
Gastric Bypass ◽  
Gastric Bypass Surgery ◽  
Somatostatin Analogs ◽  
Medical Attention ◽  
Morbidly Obese ◽  
Channel Blockers ◽  
Partial Pancreatectomy ◽  
Glucose Levels ◽  
Open Treatment ◽  
New Treatment

ObjectiveThe number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1–3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia.DesignWe explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms.ResultsGlucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements.ConclusionThese open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.

GLP-1, insulin and glucose levels during mixed test meal before and after gastric bypass surgery in obese patients

2014 ◽  
Author(s):  
Dragan Micic ◽  
Snezana Polovina ◽  
Danka Jeremic ◽  
Dusan Micic ◽  
Mirjana Sumarac-Dumanovic
Keyword(s):  
Gastric Bypass ◽  
Test Meal ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Obese Patients ◽  
Glucose Levels ◽  
Before And After

scholarly journals Mechanical colon obstruction due to the alimentary limb after Roux-en-Y gastric bypass: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Caspar Joyce Peterson ◽  
Jennifer Klasen ◽  
Tarik Delko ◽  
Romano Schneider
Keyword(s):  
Gastric Bypass ◽  
Bowel Obstruction ◽  
Transverse Colon ◽  
Bypass Surgery ◽  
Revisional Surgery ◽  
Gastric Bypass Surgery ◽  
Morbidly Obese ◽  
Tight Closure ◽  
Alimentary Limb ◽  
Colon Obstruction

Abstract Background Small bowel obstruction is a known and potentially lethal complication after gastric bypass surgery, in both the early and the late postoperative course. Colon or large bowel obstruction, on the other hand, seems to be rare after gastric bypass surgery and thus is not routinely considered. Case presentation We present the case of a 21-year old morbidly obese caucasian patient who underwent laparoscopic Roux-en-Y gastric bypass surgery and developed an early severe transverse colon obstruction due to compression of the transverse colon by the antecolic alimentary limb. Emergency revisional surgery showed a short and tense alimentary limb mesentery and possibly tight closure of Petersen’s space contributing to the compression. Through opening of Petersen’s space and mobilization of alimentary limb mesentery, decompression was achieved, and the patient fully recovered. Conclusions This is a rare case of colon obstruction caused by direct compression of the transverse colon by the antecolic alimentary limb. We propose that a combination of short tense alimentary limb mesentery and perhaps tight closure of Petersen’s space was responsible for the obstruction in this case. Surgeons and treating physicians need to be aware of such rare causes of early postoperative bowel obstruction and take these into consideration when evaluating patients.

Variation in Postoperative Analgesic Requirements in the Morbidly Obese Following Gastric Bypass Surgery

1982 ◽  
Vol 2 (1) ◽  
pp. 50-53 ◽  
Author(s):  
Richard Bennett ◽  
Randal Batenhorst ◽  
David A. Graves ◽  
Thomas S. Foster ◽  
Ward O. Griffen ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Morbidly Obese

Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery

2012 ◽  
Vol 8 (6) ◽  
pp. 770-776 ◽  
Author(s):  
Joaquin Ortega ◽  
Regina Fernandez-Canet ◽  
Sagrario Álvarez-Valdeita ◽  
Norberto Cassinello ◽  
Maria Jose Baguena-Puigcerver
Keyword(s):  
Gastric Bypass ◽  
Bypass Surgery ◽  
Psychological Symptoms ◽  
Gastric Bypass Surgery ◽  
Morbidly Obese ◽  
Obese Patients

Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects

2012 ◽  
Vol 256 (6) ◽  
pp. 1023-1029 ◽  
Author(s):  
Amanda Jiménez ◽  
Roser Casamitjana ◽  
Lílliam Flores ◽  
Judith Viaplana ◽  
Ricard Corcelles ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gastric Bypass ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Morbidly Obese ◽  
Long Term Effects ◽  
Obese Subjects

scholarly journals Liver markers, prevalence of the metabolic syndrome abnormalities and effect of Roux-en-Y gastric bypass in morbidly obese subjects

2011 ◽  
Vol 9 (4) ◽  
pp. 429-435
Author(s):  
Ary Serpa Neto ◽  
Felipe Martin Bianco Rossi ◽  
Rodrigo Dal Moro Amarante ◽  
Marçal Rossi
Keyword(s):  
Metabolic Syndrome ◽  
Gastric Bypass ◽  
Heavy Drinking ◽  
University Hospital ◽  
Morbidly Obese ◽  
Metabolic Abnormalities ◽  
Glucose Levels ◽  
The Metabolic Syndrome ◽  
Obese Subjects ◽  
Liver Markers

ABSTRACT Objectives: To evaluate the relations between liver markers (GGT, ALT and AST) and the metabolic syndrome (and its components) in morbidly obese subjects, and to determine the response of these metabolic factors and hepatic enzymes after weight loss induced by Roux-en-Y gastric bypass. Methods: This study was carried out at a university hospital, in Santo André (SP), Brazil. We evaluated 140 morbidly obese subjects aged from 18 to 60 years submitted to a Roux-en-Y gastric bypass, who were followed for a mean period of 8 months. Patients with a history of heavy drinking, type 1 diabetes, and/or liver disease were excluded. Results: Liver markers, most notably GGT, were strongly associated with metabolic abnormalities, mainly hyperglycemia. The prevalence of type 2 diabetes significantly increased with increasing levels of GGT (highest versus lowest quartile GGT: odds ratio 3.89 [95%CI: 1.07-14.17]). Liver markers significantly decreased 8 months after the Roux-en-Y gastric bypass and the reduction of GGT levels were associated with the reduction of glucose levels (Pearson r = 0.286; p = 0.001). Conclusions: Elevated levels of liver markers, principally GGT, in morbidly obese subjects are associated with metabolic abnormalities. In addition to the well-known benefits of bariatric surgery, Roux-en-Y gastric bypass, reduced the levels of liver markers to the normal range.

scholarly journals Anthropometric Measurements and Correlations to Glucometabolic and Cardiovascular Risk in Obese Patients Undergoing Gastric Bypass Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Erica Aldenbäck ◽  
Hans-Erik Johansson
Keyword(s):  
Bariatric Surgery ◽  
Vitamin D ◽  
Gastric Bypass ◽  
Fasting Glucose ◽  
Gastric Bypass Surgery ◽  
Cost Effective ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Inclusion Criteria ◽  
Sagittal Abdominal Diameter

Abdominal obesity is associated with hypertension, increased fasting glucose, HbA1c, and cholesterol. Body mass index (BMI) is frequently used to measure and define obesity and as inclusion criteria for bariatric surgery. Sagittal abdominal diameter (SAD) has been suggested to predict the amount of visceral fat, metabolic traits, and cardiometabolic risk superior to BMI. The aim was to test whether SAD has stronger correlations to glucometabolic traits compared to BMI. One hundred and fifty-five (108 women, 47 men) morbidly obese patients undergoing bariatric surgery were evaluated before (baseline), 6 and 12 months after Roux-en-Y gastric bypass (RYGBP). BMI was reduced from 43.7 kg/m2 (baseline) to 31.3 kg/m2 (12 months) and SAD from 32.6 to 23.2 cm (both p <0 .001 ). SAD correlated with CRP ( p = 0.04 ), fasting glucose ( p = 0.008 ), HbA1c ( p = 0.016 ), triglycerides ( p = 0.017 ), systolic blood pressure ( p = 0.032 ), and vitamin D ( p = 0.027 ). BMI correlated with CRP ( p = 0.006 ), triglycerides ( p = 0.016 ), vitamin D ( p = 0.002 ), and magnesium ( p = 0.037 ). Despite RYGBP surgery, vitamin D was significantly increased. Liver enzymes were significantly lowered after RYGBP and the change over time in SAD correlated with gamma-glutamyltransferase. SAD was superior to BMI to predict glucose disturbance and dyslipidemia implying increased use of SAD as it is cost effective and simple to perform in the clinic and could be of value when considering patients for bariatric surgery.

scholarly journals Investigating Intestinal Glucagon After Roux-en-Y Gastric Bypass Surgery

2019 ◽  
Vol 104 (12) ◽  
pp. 6403-6416 ◽  
Author(s):  
Tina Jorsal ◽  
Nicolai J Wewer Albrechtsen ◽  
Marie M Christensen ◽  
Brynjulf Mortensen ◽  
Erik Wandall ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Small Intestine ◽  
Gastric Bypass Surgery ◽  
Plasma Concentrations ◽  
University Hospital ◽  
Morbidly Obese ◽  
Mucosal Biopsy ◽  
Cross Sectional ◽  
Biopsy Specimens ◽  
Before And After

Abstract Context After Roux-en-Y gastric bypass (RYGB) surgery, postprandial plasma glucagon concentrations have been reported to increase. This occurs despite concomitant improved glucose tolerance and increased circulating plasma concentrations of insulin and the glucagon-inhibiting hormone glucagon-like peptide 1 (GLP-1). Objective To investigate whether RYGB-induced hyperglucagonemia may be derived from the gut. Design and Setting Substudy of a prospective cross-sectional study at a university hospital in Copenhagen, Denmark. Participants Morbidly obese individuals undergoing RYGB (n = 8) with or without type 2 diabetes. Interventions Three months before and after RYGB, participants underwent upper enteroscopy with retrieval of gastrointestinal mucosal biopsy specimens. Mixed-meal tests were performed 1 week and 3 months before and after RYGB. Main Outcome Measures The 29–amino acid glucagon concentrations in plasma and in mucosal gastrointestinal biopsy specimens were assessed using mass spectrometry–validated immunoassays, and a new monoclonal antibody reacting with immunoreactive glucagon was used for immunohistochemistry. Results Postprandial plasma concentrations of glucagon after RYGB were increased. Expression of the glucagon gene in the small intestine increased after surgery. Glucagon was identified in the small-intestine biopsy specimens obtained after, but not before, RYGB. Immunohistochemically, mucosal biopsy specimens from the small intestine harbored cells costained for GLP-1 and immunoreactive glucagon. Conclusion Increased concentrations of glucagon were observed in small-intestine biopsy specimens and postprandially in plasma after RYGB. The small intestine harbored cells immunohistochemically costaining for GLP-1 and glucagon-like immunoreactivity after RYGB. Glucagon derived from small-intestine enteroendocrine l cells may contribute to postprandial plasma concentrations of glucagon after RYGB.

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