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Nutrients handling after bariatric surgery, the role of gastrointestinal adaptation.
Camastra, Stefania; Palumbo, Maria; Santini, Ferruccio.
Afiliação
  • Camastra S; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy. stefania.camastra@med.unipi.it.
  • Palumbo M; Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, Pisa, Italy. stefania.camastra@med.unipi.it.
  • Santini F; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Eat Weight Disord ; 27(2): 449-461, 2022 Mar.
Article em En | MEDLINE | ID: mdl-33895917
ABSTRACT
Bariatric surgery determines a rearrangement of the gastrointestinal tract that influences nutrient handling and plays a role in the metabolic changes observed after surgery. Most of the changes depend on the accelerated gastric emptying observed in Roux-en-Y gastric bypass (RYGB) and, to a lesser extent, in sleeve gastrectomy (SG). The rapid delivery of meal into the jejunum, particularly after RYGB, contributes to the prompt appearance of glucose in peripheral circulation. Glucose increase is the principal determinant of GLP-1 increase with the consequent stimulation of insulin secretion, the latter balanced by a paradoxical glucagon increase that stimulates EGP to prevent hypoglycaemia. Protein digestion and amino acid absorption appear accelerated after RYGB but not after SG. After RYGB, the adaptation of the gut to the new condition participates to the metabolic change. The intestinal transit is delayed, the gut microbioma is changed, the epithelium becomes hypertrophic and increases the expression of glucose transporter and of the number of cell secreting hormones. These changes are not observed after SG. After RYGB-less after SG-bile acids (BA) increase, influencing glucose metabolism probably modulating FXR and TGR5 with an effect on insulin sensitivity. Muscle, hepatic and adipose tissue insulin sensitivity improve, and the gut reinforces the recovery of IS by enhancing glucose uptake and through the effect of the BA. The intestinal changes observed after RYGB result in a light malabsorption of lipid but not of carbohydrate and protein. In conclusion, functional and morphological adaptations of the gut after RYGB and SG activate inter-organs cross-talk that modulates the metabolic changes observed after surgery.Level of evidence Level V, narrative literature review.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Derivação Gástrica / Cirurgia Bariátrica Limite: Humans Idioma: En Revista: Eat Weight Disord Assunto da revista: GASTROENTEROLOGIA / METABOLISMO Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Itália

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Derivação Gástrica / Cirurgia Bariátrica Limite: Humans Idioma: En Revista: Eat Weight Disord Assunto da revista: GASTROENTEROLOGIA / METABOLISMO Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Itália