Volume 150, Issue 2, Pages 309-312 (February 2016) Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy: Divergent Pathways to Improved Glucose Homeostasis  Darleen Sandoval  Gastroenterology  Volume 150, Issue 2, Pages 309-312 (February 2016) DOI: 10.1053/j.gastro.2015.12.021 Copyright © 2016 AGA Institute Terms and Conditions

Figure 1 Differential effects of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on intestinal glucose handling. RYGB and VSG surgeries involve 2 drastically different anatomic rearrangements, yet each surgery has enormous beneficial effects on weight loss and type 2 diabetes mellitus. (1) Although both surgeries involve a drastic increase in nutrient delivery to the intestine via increased gastric emptying rate (GER), literature is accumulating that the intestine adapts very differently to these surgeries. (2) RYGB leads to increased GLUT1 expression and ex vivo studies examining glucose transport suggest that the intestine increases the use of glucose as a fuel for energy. (3) In the manuscript by Cavin et al, the authors hypothesize that the increased glucose consumption fuels the hyperplasia. (4) By way of this increase in intestinal tissue, there is an increase in glucagon-like peptide (GLP)-1–secreting cells and subsequently GLP-1. (5) In contrast, VSG reduced intestinal glucose transport, (6) led to an increase in the density and number of GLP-1–secreting cells without hyperplasia, and (7) increased plasma GLP-1. These data suggest distinct mechanisms by which the gastrointestinal tract functions and adapts to bariatric surgery. Gastroenterology 2016 150, 309-312DOI: (10.1053/j.gastro.2015.12.021) Copyright © 2016 AGA Institute Terms and Conditions