Page 10 - WJOLS - Laparoscopic Journal

Ricardo Lopez Osorio, Pablo Hartedt
value. In addition to this absolute requirement for insulin that this could contribute to improved glycemic control
resistance, two additional criteria of five, have to be met, after RYGB even in patients with less obesity.
to stablish MS. These included obesity, hypertension, The ghrelin hormone (GH) is a 28 amino acid peptide
dyslipidemia and microalbuminuria. presenting a unique n-octanoylation modification on
In 2001, the National Cholesterol Education Program its serine in position three, catalyzed by ghrelin O-acyl
Adult Treatment Panel III (NCEP-ATP III) defined the transferase. Ghrelin is mainly produced by a subset
MS if three or more of the following five criteria are met: of stomach cells and also by the hypothalamus, the
waist circumference over 40'' in men or 35'' in women, pituitary and other tissues. Transcriptional, translational,
blood pressure over 130/85 mm Hg, fasting triglyceride and post-translational processes generate ghrelin and
(TG) level over 150 mg/dl, fasting high-density lipopro- ghrelin-related peptides. Homo- and heterodimers of
tein (HDL) cholesterol level less than 40 mg/dl in men growth hormone secretagogue receptor, and as yet uni-
or 50 mg/dl in women and fasting blood sugar over dentified receptors, are assumed to mediate the biological
100 mg/dl. This definition does not require that any effects of acyl ghrelin and desacyl ghrelin, respectively.
specific criterion be met, only that at least three of five Ghrelin exerts wide physiological actions throughout
criteria are met. This definition will not imply that the the body, including growth hormone secretion, appetite
main cause of MS is the insulin resistance or obesity. and food intake, gastric secretion and gastrointestinal
motility, glucose homeostasis, cardiovascular functions,
METABOLIC EFFECT OF anti-inflammatory functions, reproductive functions and
BARIATRIC PROCEDURES bone formation.
Ghrelin hormone its produced in parietal cells of the
The Role of the Intestinal Hormones
fundus of the stomach, thus, in patients that undergo SG,
Previous investigations have demonstrated the rising the fundus its removed, improving the weight loss effect
levels of intestinal hormones segregated to luminal and gut hormonal response to GH suppression.
space during postoperative stages of bariatric patients. It is been described that GH levels after SG are lower

Neuroendocrinal stimulation and negative feedback than in patients with RYGB, and the overall evaluation after
in hormones in obese patients are marking an impor- 12 months, ghrelin levels maintained suppressed and

tant role in DM control and stimulation. Parietal cells in significant suppression after food intake was observed. 22
gut secrete hormones that will directly and indirectly
act over glycemic control. The peptides made in the gut BACKGROUND
and released into the circulation plays a crucial role in Several studies and have been performed to establish long-
the regulation of energy homeostasis, by signals that term outcomes for metabolic changes in bariatric sur-
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influence the central melanocortin system. These gut gery, and the main body mass index (BMI) weight loss
1,8
hormones cause hunger and satiety effects and thus, in different procedures for morbid obese patients.
have an integral role in appetite regulation. Therefore, And several meta-analysis and randomized trials, have
a gut-brain axis can be established to maintain and showed that complete and partial remission of dia betes,
regulate insulin/incretin secretion and glucagon/glucose in morbid obese patients (defined as completely no

blood levels. This gut hormones include: glucagon-like diabetes medication intake and maintained normalized
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peptide-1 (GLP-1), peptide YY (PYY), ghrelin, chole- glucose levels), after 5 years follow-up, its 78% and the
cystokinin (CCK), glucose-dependent insulinotropic reduction of overall death, in this group of patients, its
polypeptide (GIP), oxyntomodulin (OXM), and pancreatic more than 90%. 11
polypeptide (PP). This hormones act as an incretin by The effects on weight loss, and metabolic changes
augmenting the insulin response to nutrients and slo wing between the different bariatric procedures will depend on
gastric emptying inhibiting the glucagon secretion in a the patient selection for each procedure, and an adequate
glucose-dependent manner. preparation and follow-up, regardless of the main BMI
Studies performed in laboratory models, GLP-1 has of the patient before surgery. And adequate selection of
been shown to expand islet mass by stimulating pancre- patients to undergo bariatric procedures will improve the
atic b-cell proliferation and induction of islet neogenesis, patient’s outcomes. Therefore, the American Association
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and it also promotes cell differentiation. A recent study of Clinical Endocrinologists, The Obesity Society, and
by Laferrère et al showed early after Roux en-Y gastric American Society for Metabolic and Bariatric Surgery,
bypass (RYGB), the greater GLP-1 and GIP release and have already suggested guidelines for bariatric proce-
improvement of incretin effect are related not to weight dures, and suggested that bariatric procedures could
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loss but rather to the surgical procedure itself, sugges ting be performed in patients ranging from 30 to 34.9 BMI,
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