Differences in Alimentary Glucose 1 Absorption and Intestinal Disposal of Blood Glucose Following Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

International audience; Background & Aims: Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), are the most effective approaches to resolve type 2 diabetes in obese individuals. Alimentary glucose absorption and intestinal disposal of blood glucose have not been directly compared between individuals or animals that underwent RYGB vs VSG. We evaluated in rats and humans how the gut epithelium adapts following surgery and the consequences on alimentary glucose absorption and intestinal disposal of blood glucose. Methods: Obese male rats underwent RYGB, VSG, or sham (control) surgeries. We collected intestine segments from all rats; we performed histologic analyses and measured levels of mRNAs encoding the sugar transporters SGLT1, GLUT1, GLUT2, GLUT3, GLUT4 and GLUT5. Glucose transport and consumption were assayed using ex vivo jejunal loops. Histologic analyses were also performed on Roux limb sections from patients who underwent RYGB, 1–5 years after surgery. Roux limb glucose consumption was assayed following surgery by positron emission and computed tomography imaging.Results: In rats and humans that underwent RYGB, the Roux limb became hyperplasic, with an increased number of incretin-producing cells, compared with the corresponding jejunal segment of controls. Furthermore, expression of sugar transporters and hypoxia-related genes increased and the non-intestinal glucose transporter GLUT1 appeared at the basolateral membrane of enterocytes. Ingested and circulating glucose was trapped within the intestinal epithelial cells of rats and humans that underwent RYGB. By contrast, there was no hyperplasia of the intestine after VSG, but the intestinal absorption of alimentary glucose was reduced and density of endocrine cells secreting glucagon-like peptide-1 (GLP1) increased. Conclusions: The intestine adapts differently to RYGB vs VSG. RYGB increases intestinal glucose disposal, whereas VSG delays glucose absorption; both contribute to observed improvements in glycemia.