The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control
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Gastric bypass leads to the remission of type 2 diabetes independently of weight loss. Our hypothesis is that changes in bile flow due to the altered anatomy may partly explain the metabolic outcomes of the operation. We prospectively studied 12 patients undergoing gastric bypass and six patients undergoing gastric banding over a 6-wk period. Plasma fibroblast growth factor (FGF)19, stimulated by bile acid absorption in the terminal ileum, and plasma bile acids were measured. In canine and rodent models, we investigated changes in the gut hormone response after altered bile flow. FGF19 and total plasma bile acids levels increased after gastric bypass compared with no change after gastric banding. In the canine model, both food and bile, on their own, stimulated satiety gut hormone responses. However, when combined, the response was doubled. In rats, drainage of endogenous bile into the terminal ileum was associated with an enhanced satiety gut hormone response, reduced food intake, and lower body weight. In conclusion, after gastric bypass, bile flow is altered, leading to increased plasma bile acids, FGF19, incretin. and satiety gut hormone concentrations. Elucidating the mechanism of action of gastric bypass surgery may lead to novel treatments for type 2 diabetes.
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Increased circulating bile acids have been linked to increased GLP-1 and reduced glucose and triglyceride levels.
“Increased circulating levels of primary and secondary bile acids have been observed after RYGB (Ahmad et al., 2013; Glicksman et al., 2010; Kohli et al., 2013; Patti et al., 2009) and have been linked to increased GLP-1 and reduced glucose and triglyceride levels (Nakatani et al., 2009; Patti et al., 2009; Pournaras et al., 2012; Simonen et al., 2012).”
From Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation (2015) · cites this paper as Pournaras et al., 2012
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References 40 · Cited by 383
- Authors
- Pournaras, D. J., Glicksman, C., Vincent, R. P., Kuganolipava, S., Alaghband-Zadeh, J., Mahon, D., Bekker, J. H. R., Ghatei, M. A., Bloom, S. R., Walters, J. R. F., Welbourn, R., & le Roux, C. W.
- Affiliations
- Musgrove Park Hospital (GB)
- King's College Hospital (GB)
- Imperial College London (GB)
- University of Pretoria (ZA)
- Department of Investigative Medicine (D.J.P., R.P.V., M.A.G., S.R.B., C.W.l.R.), Imperial Weight Centre, Imperial College London, London W6 8RF, United Kingdom
- Venue
- Endocrinology
- Publisher
- The Endocrine Society
- Published
- 2012-06-06
- Volume
- 153
- Issue
- 8
- Pages
- 3613-3619
- ISSN
- 0013-7227 (ISSN-L)
- 1945-7170
- PMC
- PMC3404349
- OpenAlex
- W1974800489
- Cited by
- 383
- References
- 40
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 11 · 2023: 13 · 2022: 16 · 2021: 25 · 2020: 27 · 2019: 34 · 2018: 27 · 2017: 39 · 2016: 44 · 2015: 55 · 2014: 34 · 2013: 42 · 2012: 2
- FWCI
- 43.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrinology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- UpSpace Institutional Repository (University of Pretoria) (submittedVersion)
- Funders
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research (DHCS/05/05)
- Imperial College London
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
- Keywords
- Roux-en-Y gastric bypass, bile flow, bile acids, FGF19, type 2 diabetes remission, weight loss, gastric banding, incretins, terminal ileum, dietary intake, bariatric surgery
- MeSH terms
- Adult, Animals, Bile, Bile Acids and Salts, Blood Glucose, C-Reactive Protein, Calorimetry, Diabetes Mellitus, Type 2, Dogs, Female, Fibroblast Growth Factors, Humans, Male, Middle Aged, Gastric Bypass, Weight Loss, Rats, Wistar, Peptide YY, Rats, Glucagon-Like Peptide 1
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