Weihang Wu1, Li Lin2, Zhixiong Lin2, Weijin Yang1, Zhicong Cai2, Jie Hong3, Jiandong Qiu2, Chen Lin1, Nan Lin4, Yu Wang5,6. 1. Department of General Surgery, Fuzhou General Hospital of the PLA, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China. 2. Clinical Institute of Fuzhou General Hospital, Fujian Medical University, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China. 3. Clinical Institute of Fuzhou General Hospital, Fujian University of Traditional Chinese Medicine, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China. 4. Department of General Surgery, Fuzhou General Hospital of the PLA, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China. 703039980@qq.com. 5. Department of General Surgery, Fuzhou General Hospital of the PLA, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China. flyfishwang@hotmail.com. 6. Department of General Surgery, Dongfang Hospital, Xiamen University, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China. flyfishwang@hotmail.com.
Abstract
BACKGROUND: Several studies have found that metabolic surgery can significantly improve glucose homeostasis; however, the intrinsic mechanisms remain unclear. Accumulating evidence suggests that duodenal bypass plays a crucial role in the treatment of type 2 diabetes mellitus (T2DM). Here, we aimed to evaluate the effect of duodenal reflux on glucose metabolism in T2DM. METHODS: A high-fat diet and low-dose streptozotocin (STZ) administration were used to induce T2DM in male rats, which were assigned to three experimental groups: sham operation (SO; n = 10), new duodenal-jejunal bypass (NDJB; n = 10), and new duodenal-jejunal bypass with a tube (NDJBT; n = 10). Weight, food intake, oral glucose tolerance test (OGTT) results, glucagon-like peptide 1 (GLP-1) levels, and histopathology were assessed before or after surgery. Plain abdominal radiography was performed 1 week after the operation. RESULTS: Plain abdominal radiography indicated the occurrence of contrast agent reflux into the duodenum. The body weight and food intake in all three groups did not significantly differ before and after surgery. The NDJB and particularly the NDJBT groups exhibited better glucose tolerance, lower fasting blood glucose (FBG) levels, lower area under the curves for OGTT (AUCOGTT) values, and higher GLP-1 levels, as compared with the sham group postoperatively. The villus height and crypt depth were both shorter in the biliopancreatic limb after NDJBT, as compared with those after SO and NDJB. CONCLUSIONS: Thus, exclusion of the duodenum alone and tube placement can effectively prevent duodenal reflux and improve glucose homeostasis, which further suggests that the duodenum plays an important role in T2DM.
BACKGROUND: Several studies have found that metabolic surgery can significantly improve glucose homeostasis; however, the intrinsic mechanisms remain unclear. Accumulating evidence suggests that duodenal bypass plays a crucial role in the treatment of type 2 diabetes mellitus (T2DM). Here, we aimed to evaluate the effect of duodenal reflux on glucose metabolism in T2DM. METHODS: A high-fat diet and low-dose streptozotocin (STZ) administration were used to induce T2DM in male rats, which were assigned to three experimental groups: sham operation (SO; n = 10), new duodenal-jejunal bypass (NDJB; n = 10), and new duodenal-jejunal bypass with a tube (NDJBT; n = 10). Weight, food intake, oral glucose tolerance test (OGTT) results, glucagon-like peptide 1 (GLP-1) levels, and histopathology were assessed before or after surgery. Plain abdominal radiography was performed 1 week after the operation. RESULTS: Plain abdominal radiography indicated the occurrence of contrast agent reflux into the duodenum. The body weight and food intake in all three groups did not significantly differ before and after surgery. The NDJB and particularly the NDJBT groups exhibited better glucose tolerance, lower fasting blood glucose (FBG) levels, lower area under the curves for OGTT (AUCOGTT) values, and higher GLP-1 levels, as compared with the sham group postoperatively. The villus height and crypt depth were both shorter in the biliopancreatic limb after NDJBT, as compared with those after SO and NDJB. CONCLUSIONS: Thus, exclusion of the duodenum alone and tube placement can effectively prevent duodenal reflux and improve glucose homeostasis, which further suggests that the duodenum plays an important role in T2DM.
Entities:
Keywords:
Intestinal histology; Metabolic surgery; New duodenal-jejunal bypass; Radiography; Reflux
Authors: Juliana C N Chan; Vasanti Malik; Weiping Jia; Takashi Kadowaki; Chittaranjan S Yajnik; Kun-Ho Yoon; Frank B Hu Journal: JAMA Date: 2009-05-27 Impact factor: 56.272