Mans Esther, Serra-Prat Mateu, Palomera Elisabet, Suñol Xavier, Clavé Pere
General Surgery Department,
Research Unit, and Center for Biomedical Research Network of Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; and.
Am J Clin Nutr. 2015 Sep;102(3):540-7. doi: 10.3945/ajcn.114.104307. Epub 2015 Jul 22.
The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined.
The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test.
Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h.
No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients.
Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after surgery. This trial was registered at clinicaltrials.gov as NCT02414893.
病态肥胖患者接受袖状胃切除术后，饥饿、饱腹感与胃肠道综合动力及激素反应之间的关系尚未明确。
评估袖状胃切除术对液体餐试验后饥饿、饱腹感、胃和胆囊动力以及胃肠激素反应的影响。
研究了三组：病态肥胖患者（n = 16）、接受袖状胃切除术的病态肥胖患者（n = 8）和非肥胖患者（n = 16）。参与者禁食10小时，然后摄入200毫升液体餐（400千卡 + 1.5克对乙酰氨基酚）。在4小时内多次测量空腹及餐后的饥饿感、饱腹感、激素浓度以及胃和胆囊排空情况。
病态肥胖组和非肥胖组之间在饥饿和饱腹感曲线上未观察到差异；然而，袖状胃切除术患者比其他组饥饿感更低且饱腹感更强。病态肥胖患者空腹时胃窦面积在统计学上显著大于非肥胖组和袖状胃切除术组。与其他两组（结果非常相似）相比，袖状胃切除术组的胃排空加速。三组的胆囊排空情况相似。袖状胃切除术患者的胃饥饿素浓度最低，餐后早期胆囊收缩素和胰高血糖素样肽1峰值高于其他参与者。与病态肥胖患者相比，该组还表现出胰岛素抵抗模式改善。
袖状胃切除术似乎与胃肠道生理的深刻变化有关，这些变化有助于减少饥饿感并增加饱腹感。这些变化包括胃排空加速、餐后胆囊收缩素和胰高血糖素样肽1浓度升高以及胃饥饿素释放减少，这些共同作用可能有助于患者术后减重并改善糖代谢。该试验已在clinicaltrials.gov上注册，注册号为NCT02414893。
