The findings support the effects of BAs on satiety , lipid and cholesterol metabolism , incretins and glucose homoeostasis , energy metabolism , gut microbiota and endoplasmic reticulum stress following bariatric surgery .
Many of these metabolic effects are modulated through the BA receptors FXR and TGR5 .
We also explore a possible link between BAs and carcinogenesis following bariatric surgery .
Conclusions : Overall there is good evidence to support the role of BAs in the metabolic effects of bariatric surgery through the above mechanisms .
BAs could serve as a novel therapeutic pharmacological target for the treatment of obesity and its associated co-morbidities
Background : Bariatric surgery is currently the most efficacious treatment for obesity and its associated metabolic co-morbidities , such as diabetes .
The metabolic improvements occur through both weight-dependent and weight-independent mechanisms .
Bile acids ( BAs ) have emerged as key signalling molecules that have a central role in modulating many of the physiological effects seen after bariatric surgery .
This systematic review assesses the evidence from both human and animal studies for the role of BAs in reducing the metabolic complications of obesity following bariatric surgery .
Physiological control of cholecystokinin release and pancreatic enzyme secretion by intraduodenal bile acids.
BACKGROUND : The physiological relevance of duodenal bile acids in the control of cholecystokinin release and pancreatic enzyme secretion is still unknown . AIMS : To provide a near physiological situation by perfusing a bile acid mixture mimicking the individual endogenous bile acid composition of the person under investigation . For maximal reduction of endogenous bile output the CCK-A receptor antagonist loxiglumide was infused intravenously . SUBJECTS AND METHODS : Seven healthy volunteers were studied on four different days by a duodenal marker perfusion technique . The individual bile acid composition in duodenal juice and test meal stimulated bile acid output was assessed on day 1 . Bile acids were perfused at an amount of 30 or 100 % as determined on day 1 in combination with the test meal in the presence or absence of loxiglumide . Pancreatic enzymes , bilirubin , and bile acid output were determined in duodenal juice . Plasma cholecystokinin ( CCK ) and plasma pancreatic polypeptide ( PP ) were measured radioimmunologically . RESULTS : Bile acid perfusion did not significantly alter stimulated pancreatic enzyme , bilirubin or bile acid output or plasma CCK . Loxiglumide did not alter basal CCK release but increased test meal stimulated CCK output fourfold ( p < 0.05 ) . The addition of bile acids to the test meal at a dose resembling 30 % of bile acid output as determined on day 1 prevented this increase . Plasma PP concentration remained unchanged by bile acids and were mostly undetectable during loxiglumide infusion . CONCLUSIONS : The CCK producing cell is under constant suppression by intraduodenal bile acids which can not be further enhanced by a physiological bile acid mixture . However , removal of duodenal bile acids by inhibition of gall bladder contraction unmasks this suppression leading to a dramatic increase in plasma CCK levels . As little as one third of postpr and ially released bile acids completely reverse this effect . Bile acids are the most important luminal regulator of CCK release in humans
The findings support the effects of BAs on satiety , lipid and cholesterol metabolism , incretins and glucose homoeostasis , energy metabolism , gut microbiota and endoplasmic reticulum stress following bariatric surgery .
Many of these metabolic effects are modulated through the BA receptors FXR and TGR5 .
We also explore a possible link between BAs and carcinogenesis following bariatric surgery .
Conclusions : Overall there is good evidence to support the role of BAs in the metabolic effects of bariatric surgery through the above mechanisms .
BAs could serve as a novel therapeutic pharmacological target for the treatment of obesity and its associated co-morbidities
Background : Bariatric surgery is currently the most efficacious treatment for obesity and its associated metabolic co-morbidities , such as diabetes .
The metabolic improvements occur through both weight-dependent and weight-independent mechanisms .
Bile acids ( BAs ) have emerged as key signalling molecules that have a central role in modulating many of the physiological effects seen after bariatric surgery .
This systematic review assesses the evidence from both human and animal studies for the role of BAs in reducing the metabolic complications of obesity following bariatric surgery .