Bariatric surgery; obesity; incretins; intestinal hormones; type 2 diabetes; gastric bypass; metabolic surgery
Abstract :
[fr] La chirurgie bariatrique a prouvé son efficacité pour obtenir une perte de poids importante et soutenue, et améliorer considérablement le profil métabolique des patients obèses diabétiques de type 2. La rémission du diabète de type 2, souvent observée, apparaît précocement, avant même l’obtention d’un amaigrissement majeur. Elle paraît de plus en plus résulter d’une modification des hormones digestives impliquées dans la régulation du comportement alimentaire et dans l’homéostasie glycémique, plutôt que d’une simple restriction mécanique ou d’une malabsorption plus ou moins importante des aliments ingérés imposée par la procédure chirurgicale. Ces modifications hormonales résultent d’une amputation partielle de l’estomac (amenant une diminution de la sécrétion de ghréline), d’un court-circuitage de la partie proximale de l’intestin grêle (conduisant à une perte de sécrétion de facteurs encore mal connus susceptibles d’entraver l’action et/ou la sécrétion de l’insuline) et d’un contact plus précoce des aliments avec la partie distale de l’intestin (stimulant la sécrétion des hormones incrétines de type glucagon-like peptide-1 [GLP-1] par les cellules L iléales, du neuropeptide YY et de l’oxyntomoduline). La meilleure connaissance de ces mécanismes physiopathologiques, particulièrement bien étudiés en ce qui concerne la dérivation gastrique avec anse de Roux en Y, a conduit récemment à une innovation dans les techniques chirurgicales proposées visant une chirurgie métabolique et non plus simplement une chirurgie bariatrique. [en] Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission of diabetes occurs very early, before any significant weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. These hormonal changes result from partial stomach amputation (leading to reduced ghrelin secretion), from bypass of duodenal-jejunal foregut (leading to reduced secretion of still unknown factors that may counteract insulin secretion and/or action) and from an earlier contact of food with hindgut (leading to enhanced secretion of incretin hormones such as glucagon-like peptide-1 [GLP-1] by the ileal L cells, neuropeptide YY and oxyntomodulin). The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery.
Disciplines :
Surgery Endocrinology, metabolism & nutrition
Author, co-author :
SCHEEN, André ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
DE FLINES, Jenny ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
DE ROOVER, Arnaud ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
PAQUOT, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Language :
French
Title :
Le tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique
Alternative titles :
[en] The digestive tract as an endocrine organ: Bariatric surgery revisited
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