Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Cell Mol Gastroenterol Hepatol. 2019;8(2):235-246. doi: 10.1016/j.jcmgh.2019.04.014. Epub 2019 May 7.
Bariatric surgery is the most effective and durable treatment for morbid obesity, with an unexplained yet beneficial side effect of restoring insulin sensitivity and improving glycemia, often before weight loss is observed. Among the many contributing mechanisms often cited, the altered handling of intestinal bile acids is of considerable therapeutic interest. Here, we review a growing body of literature examining the metabolic effects of bile acids ranging from their physical roles in dietary fat handling within the intestine to their functions as endocrine and paracrine hormones in potentiating responses to bariatric surgery. The roles of 2 important bile acid receptors, Takeda G-protein coupled receptor (also known as G-protein coupled bile acid receptor) and farnesoid X receptor, are highlighted as is downstream signaling through glucagon-like polypeptide 1 and its cognate receptor. Additional improvements in other phenotypes and potential contributions of commensal gut bacteria, such as Akkermansia muciniphila, which are manifest after Roux-en-Y gastric bypass and other emulations, such as gallbladder bile diversion to the ileum, are also discussed.
减重手术是治疗病态肥胖最有效和持久的方法，其具有一种尚未阐明但有益的副作用，即恢复胰岛素敏感性并改善血糖水平，而这种作用往往在观察到体重减轻之前就出现了。在经常被引用的众多促成机制中，肠道胆汁酸的改变处理方式具有相当大的治疗意义。在这里，我们回顾了越来越多的文献，这些文献研究了胆汁酸的代谢作用，从它们在肠道内对膳食脂肪处理的物理作用到它们作为内分泌和旁分泌激素在增强对减重手术反应中的作用。突出了 2 种重要的胆汁酸受体，即 Takeda G 蛋白偶联受体（也称为 G 蛋白偶联胆汁酸受体）和法尼醇 X 受体，以及通过胰高血糖素样肽 1 及其同源受体的下游信号传导。还讨论了其他表型的进一步改善，以及共生肠道细菌（如 Akkermansia muciniphila）的潜在贡献，这些在 Roux-en-Y 胃旁路手术后以及其他模拟手术（如将胆囊胆汁引流到回肠）后表现出来。
