J. Miholic et al., POSTPRANDIAL RELEASE OF GLUCAGON-LIKE PEPTIDE-1, PANCREATIC GLUCAGON,AND INSULIN AFTER ESOPHAGEAL RESECTION, Digestion, 54(2), 1993, pp. 73-78
Postprandial concentrations of glucose and the immunoreactivity of ins
ulin. glucagon-like peptide-1 (GLP-1), and pancreatic glucagon were me
asured in 10 patients who had undergone esophageal resection (ER) and
replacement by the stomach. Emptying of the esophageal substitute was
assessed by scintigraphy using a Tc-99-labeled solid test meal. The da
ta were compared with measurements performed in 14 controls, in 7 of w
hom gastric emptying was measured. The gastric emptying half time was
6.8 +/- 6.2 min (median 144 s) in ER cases, significantly shorter than
in controls: 70 +/- 29 min (median 51 min). The early integrated (fir
st 30 min) and total integrated insulin and GLP-1 concentrations were
significantly higher than in controls. In 3 of 10 esophagectomy patien
ts the blood glucose concentration fell below 3.8 mmol/l postprandiall
y. High GLP-1 concentrations in the first 30 min were associated with
low serum glucose during the 2nd h postprandially when all the hypogly
cemic episodes occurred. It is concluded that rapid emptying of the es
ophageal substitute induces the exaggerated GLP-1 response, which is a
main factor for reactive hypoglycemia.