Distal gastric mucosa ablation induces significant weight loss and improved glycemic control in type 2 diabetes Sprague–Dawley rat model

Abstract

Background

Excluding the foregut (distal stomach and duodenum) from food transit in RYGB normalizes glucose tolerance. Excluding/removing the duodenal mucosa partly improves glycemic control. So far, the effect of excluding/removing the gastric mucosa remains unknown.

Objective

To observe the effect of removing the distal gastric mucosa on glucose tolerance.

Method

Thirty fatty Sprague–Dawley rats received low-dose streptozotocin (STZ) to induce type 2 diabetes (T2D), then randomly assigned to Roux-en-Y gastric bypass (RYGB, n = 8), distal gastric mucosa removal (DGMR, n = 8), duodenal–jejunal bypass (DJB, n = 8), and Sham (n = 6) groups. In the DGMR group, the distal third of the gastric mucosa was removed by thermal ablation using an electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed-meal tolerance test (MMTT) were repeated 3 and 6 weeks postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded.

Results

Gastrin AUC decreased significantly (p < 0.05) in the DGMR group after surgery. A significantly increased GLP-1 AUC was found in the RYGB, DGMR, and DJB groups at week 3 and only the RYGB group at week 6 postoperatively. The improved glucose tolerance in the RYGB group was significantly greater than the improved glucose tolerance in the DGMR and DJB groups. The improved glucose tolerance 3 and 6 weeks after surgery in the DGMR group was significantly greater than the improved glucose tolerance in the DJB group. Body weight decreased significantly in the RYGB, DGMR, and DJB groups postoperatively.

Conclusion

Removing the distal gastric mucosa induced significant weight loss and improved glycemic control in T2D SD rat model. Therefore, the gastric mucosa exclusion in RYGB may be key to the weight loss and diabetes remission, which perhaps warrants a new theory.

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Funding

Funding was provided by Natural Science Foundation of Jiangsu Province (2015102015).

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Authors

Contributions

PRD and XZ designed the experiment. PRD performed the experiment and drafted the manuscript. CL and XZ supervised the experiment and offered technical support. LY, JW, and JH revised the manuscript, and KH provided material and logistical support.

Corresponding author

Correspondence to Xiaocheng Zhu.

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Disclosures

Dr. Ponnie Robertlee Dolo, Dr. Ke Huang, Dr. Jason Widjaja, Dr. Chao Li, Dr. Xiaocheng Zhu, Dr. Libin Yao, and Dr. Jian Hong have no conflict of interest or financial ties to disclose.

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Not applicable (there were no human participants).

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All applicable institutional and national guidelines of the People’s Republic of China for the care and use of animals were followed.

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Dolo, P.R., Huang, K., Widjaja, J. et al. Distal gastric mucosa ablation induces significant weight loss and improved glycemic control in type 2 diabetes Sprague–Dawley rat model. Surg Endosc 34, 4336–4346 (2020). https://doi.org/10.1007/s00464-019-07200-3

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Keywords

  • Gastric bypass
  • Type 2 diabetes
  • Foregut
  • Gastric mucosa
  • GLP-1
  • Gastrin