Mechanism Study Progress of Gastrointestinal Bypass Operation on Treatment of Type 2 Diabetes Mellitus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Yamin , LI Fei , ZHANG Di.

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, ChinaCorresponding Author: ZHENG Ya-min, E-mail: cpuzym@sina.com;

Corresponding author：

Keywords：

Type 2 diabetes mellitus; Gastric bypass operation

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Objective 　To study the mechanism of gastric bypass operation on treatment of type 2 diabetes mellitus, recognize the etiology and pathogenesy of the disease and frame therapy strategy for type 2 diabetes mellitus.
Methods 　The literatures about gastric bypass operation on treatment of type 2 diabetes mellitus, including clinical cases reports and evidence-based studies were reviewed.
Results 　Gastrointestinal bypass operation was regarded as an effective treatment for type 2 diabetes mellitus. There were three hypotheses of therapy mechanism: early delivery of nutrients to the distal intestine, exclusion of the proximal intestine and incretin/anti-incretin.
Conclusion 　Gastrointestinal bypass operation is now considering as an effective treatment, there is still a lack of basic experimental studies to clarify the mechanism.

Citation： ZHENG Yamin,LI Fei,ZHANG Di.. Mechanism Study Progress of Gastrointestinal Bypass Operation on Treatment of Type 2 Diabetes Mellitus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(10): 866-868. doi: Copy

1.	Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus [Ｊ]. Ann Surg, 1995; 222(3): 339-350.
2.	Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
3.	Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis [Ｊ]. Diabetes Care, 2008; 31 Suppl 2: S290-S296.
4.	Sjstrm L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery [Ｊ]. N Engl J Med, 2004; 351(26): 2683-2693.
5.	Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity [Ｊ]. Obes Surg, 2007; 17(2): 176-184.
6.	Meneghini LF. Impact of bariatric surgery on type 2 diabetes [Ｊ]. Cell Biochem Biophys, 2007; 48(2-3): 97-102.
7.	Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
8.	Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3-60 month follow-up [Ｊ]. Obes Surg, 2000; 10(3): 233-239.
9.	Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis [Ｊ]. JAMA, 2004; 292(14): 1724-1737.
10.	Mingrone G, DeGaetano A, Greco AV, et al. Reversibility of insulin resistance in obese diabetic patients: role of plasma lipids [Ｊ]. Diabetologia, 1997; 40(5): 599-605.
11.	Noya G, Cossu ML, Coppola M, et al. Biliopancreatic diversion preserving the stomach and pylorus in the treatment of hypercholesterolemia and diabetes type Ⅱ: results in the first 10 cases [Ｊ]. Obes Surg, 1998; 8(1): 67-72.
12.	Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study [Ｊ]. World J Surg, 1996; 20(1): 60-66.
13.	Pories WJ, Albrecht RJ. Etiology of type Ⅱ diabetes mellitus: role of the foregut [Ｊ]. World J Surg, 2001; 25(4): 527-531.
14.	Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery [Ｊ]. N Engl J Med, 2007; 357(8): 753-761.
15.	Kannel WB, McGee DL. Diabetes and cardiovascular disea-se. The Framingham study [Ｊ]. JAMA, 1979; 241(19): 2035-2038.
16.	Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality: the problem with small sample size [Ｊ]. JAMA, 2004; 292(7): 847-851.
17.	Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13 871 morbidly obese patients from a national registry [Ｊ]. Ann Surg, 2007; 246(6): 1002-1007.
18.	Nguyen NT, Hinojosa M, Fayad C, et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers [Ｊ]. J Am Coll Surg, 2007; 205(2): 248-255.
19.	Han SH, Gracia C, Mehran A, et al. Improved outcomes us-ing a systematic and evidence-based approach to the laparoscopic Roux-en-Y gastric bypass in a single academic institution [Ｊ]. Am Surg, 2007; 73(10): 955-958.
20.	Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes [Ｊ]. Ann Surg, 2006; 244(5): 741-749.
21.	Mason EE. Ileal [correction of ilial] transposition and enteroglucagon/GLP-1 in obesity (and diabetic?) surgery [Ｊ]. Obes Surg, 1999; 9(3): 223-228.
22.	Patriti A, Facchiano E, Annetti C, et al. Early improvement of glucose tolerance after ileal transposition in a non-obese type 2 diabetes rat model [Ｊ]. Obes Surg, 2005; 15(9): 1258-1264.
23.	Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus [Ｊ]. Ann Surg, 2002; 236(5): 554-559.
24.	Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism [Ｊ]. Ann Surg, 2004; 240(2): 236-242.
25.	le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters [Ｊ]. Ann Surg, 2006; 243(1): 108-114.
26.	Suzuki S, Ramos EJ, Goncalves CG, et al. Changes in GI hormones and their effect on gastric emptying and transit times after Roux-en-Y gastric bypass in rat model [Ｊ]. Surgery, 2005; 138(2): 283-290.
27.	Morínigo R, Lacy AM, Casamitjana R, et al. GLP-1 and ch-anges in glucose tolerance following gastric bypass surgery in morbidly obese subjects [Ｊ]. Obes Surg, 2006; 16(12): 1594-1601.
28.	Moo TA, Rubino F. Gastrointestinal surgery as treatment for type 2 diabetes [Ｊ]. Curr Opin Endocrinol Diabetes Obes, 2008; 15(2): 153-158.
29.	Baggio LL, Drucker DJ. Biology of incretins: GLP-1 and GIP [Ｊ]. Gastroenterology, 2007; 132(6): 2131-2157.
30.	Drucker DJ. Glucagon-like peptide-1 and the islet beta-cell: augmentation of cell proliferation and inhibition of apoptosis [Ｊ]. Endocrinology, 2003; 144(12): 5145-5148.
31.	Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery [Ｊ]. N Engl J Med, 2005; 353(3): 249-254.

1. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus [Ｊ]. Ann Surg, 1995; 222(3): 339-350.
2. Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
3. Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis [Ｊ]. Diabetes Care, 2008; 31 Suppl 2: S290-S296.
4. Sjstrm L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery [Ｊ]. N Engl J Med, 2004; 351(26): 2683-2693.
5. Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity [Ｊ]. Obes Surg, 2007; 17(2): 176-184.
6. Meneghini LF. Impact of bariatric surgery on type 2 diabetes [Ｊ]. Cell Biochem Biophys, 2007; 48(2-3): 97-102.
7. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
8. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3-60 month follow-up [Ｊ]. Obes Surg, 2000; 10(3): 233-239.
9. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis [Ｊ]. JAMA, 2004; 292(14): 1724-1737.
10. Mingrone G, DeGaetano A, Greco AV, et al. Reversibility of insulin resistance in obese diabetic patients: role of plasma lipids [Ｊ]. Diabetologia, 1997; 40(5): 599-605.
11. Noya G, Cossu ML, Coppola M, et al. Biliopancreatic diversion preserving the stomach and pylorus in the treatment of hypercholesterolemia and diabetes type Ⅱ: results in the first 10 cases [Ｊ]. Obes Surg, 1998; 8(1): 67-72.
12. Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study [Ｊ]. World J Surg, 1996; 20(1): 60-66.
13. Pories WJ, Albrecht RJ. Etiology of type Ⅱ diabetes mellitus: role of the foregut [Ｊ]. World J Surg, 2001; 25(4): 527-531.
14. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery [Ｊ]. N Engl J Med, 2007; 357(8): 753-761.
15. Kannel WB, McGee DL. Diabetes and cardiovascular disea-se. The Framingham study [Ｊ]. JAMA, 1979; 241(19): 2035-2038.
16. Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality: the problem with small sample size [Ｊ]. JAMA, 2004; 292(7): 847-851.
17. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13 871 morbidly obese patients from a national registry [Ｊ]. Ann Surg, 2007; 246(6): 1002-1007.
18. Nguyen NT, Hinojosa M, Fayad C, et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers [Ｊ]. J Am Coll Surg, 2007; 205(2): 248-255.
19. Han SH, Gracia C, Mehran A, et al. Improved outcomes us-ing a systematic and evidence-based approach to the laparoscopic Roux-en-Y gastric bypass in a single academic institution [Ｊ]. Am Surg, 2007; 73(10): 955-958.
20. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes [Ｊ]. Ann Surg, 2006; 244(5): 741-749.
21. Mason EE. Ileal [correction of ilial] transposition and enteroglucagon/GLP-1 in obesity (and diabetic?) surgery [Ｊ]. Obes Surg, 1999; 9(3): 223-228.
22. Patriti A, Facchiano E, Annetti C, et al. Early improvement of glucose tolerance after ileal transposition in a non-obese type 2 diabetes rat model [Ｊ]. Obes Surg, 2005; 15(9): 1258-1264.
23. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus [Ｊ]. Ann Surg, 2002; 236(5): 554-559.
24. Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism [Ｊ]. Ann Surg, 2004; 240(2): 236-242.
25. le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters [Ｊ]. Ann Surg, 2006; 243(1): 108-114.
26. Suzuki S, Ramos EJ, Goncalves CG, et al. Changes in GI hormones and their effect on gastric emptying and transit times after Roux-en-Y gastric bypass in rat model [Ｊ]. Surgery, 2005; 138(2): 283-290.
27. Morínigo R, Lacy AM, Casamitjana R, et al. GLP-1 and ch-anges in glucose tolerance following gastric bypass surgery in morbidly obese subjects [Ｊ]. Obes Surg, 2006; 16(12): 1594-1601.
28. Moo TA, Rubino F. Gastrointestinal surgery as treatment for type 2 diabetes [Ｊ]. Curr Opin Endocrinol Diabetes Obes, 2008; 15(2): 153-158.
29. Baggio LL, Drucker DJ. Biology of incretins: GLP-1 and GIP [Ｊ]. Gastroenterology, 2007; 132(6): 2131-2157.
30. Drucker DJ. Glucagon-like peptide-1 and the islet beta-cell: augmentation of cell proliferation and inhibition of apoptosis [Ｊ]. Endocrinology, 2003; 144(12): 5145-5148.
31. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery [Ｊ]. N Engl J Med, 2005; 353(3): 249-254.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Mechanism Study Progress of Gastrointestinal Bypass Operation on Treatment of Type 2 Diabetes Mellitus

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