POSTPRANDIAL RELEASE OF GLUCAGON-LIKE PEPTIDE-1, PANCREATIC GLUCAGON,AND INSULIN AFTER ESOPHAGEAL RESECTION

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.