GASTROINTESTINAL HORMONES AND GASTRIC-EMPTYING 20 YEARS AFTER JEJUNOILEAL BYPASS FOR MASSIVE OBESITY

OBJECTIVE: Some studies have shown a more rapid gastric emptying in ob ese subjects. Six to twelve months after jejunoileal bypass (JIB) neur otensin (NT) and enteroglucagon have been shown to be elevated after f ood intake. These hormones, together with peptide YY (PYY) and glucago n-like peptide-1 (GLP-1) have been implicated in the reduction of uppe r gastrointestinal motility seen after infusion of nutrients into the ileum. AIM: To study if the postprandial gut hormone pattern and gastr ic emptying is altered 20 y after JIB. SUBJECTS: Seven subjects operat ed with JIB a mean (s.d.) 20 +/- 3 y ago, with a BMI of 44 +/- 4 kg/m( 2) at the time of surgery and 31 +/- 4 at present. For comparison seve n sex-matched non-operated obese controls (BMI 43 +/- 3) were studied. METHODS: Serial blood samples were obtained every 10 min after intake of a 280 kcal meal. Radioimmunoassays for motilin, cholecystokinin (C CK), NT, PW and GLP-1 were performed. Gastric emptying of a solid meal was studied using a radioactively labelled omelette (of 310 kcal) for 120 min). RESULTS: After JIB postprandial motilin, CCK, NT, PYY and G LP-1 were elevated compared to non-operated obese subjects. Similarly, basal levels of CCK, motilin, GLP-1 and PYY were elevated in the oper ated group. No difference was observed in the rate of gastric emptying between the two groups. CONCLUSION: Both fasting and postprandial gut hormone levels are elevated 20 y after JIB. The impact of long-term r apid stimulation of the ileum and subsequent raised gut hormone levels on gastric emptying is not clear.