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thank you thank you very much your chairman your audience mine is then oh dear
00:00:05
and variant rig research fellow in p. s. u. student at university hospital zurich
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and honour to present our clinical case study and metabolic response of the gastric bypass
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reason high quality evidence shows that an barrier took surgeries
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not only fact even using weight loss nobody's individuals
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but also to to read come or b. b. t.'s especially type two diabetes now it is
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and accordingly the news guidelines of diabetes care included
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geriatric surgery in the treatment algorithm however
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underline physiological mechanisms they drive these beneficial changes are not entirely on this to it
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it's been observed that there are way bills independent as facts of area trick surgery
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on a that today beaches improvement also be different directory procedures have a different effect
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an outcome and it's been suggested that got home once played a key role
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this goes back to almost twenty years ago when professor ruby no came up with a framework
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to interpret um in fact of gastric bypass include cause i'm mad doubled isn't
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and uh he he he uh name does the hangup and forgot hypothesis
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according to how i got harcourt is is that and i just eat fruit
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gets into contact with more distant part of small bowel more quickly
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and this leads to add more potent a response in got hormone surges g. l. p. one p.
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y. y. g. i. p. so called including hormones that stimulate depend crest to produce more easily
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according to the forgot hypotheses the food will not get into contact with the with the moment goes up
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and does the so called hunting fucking factor will not be secreted
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however so far no one ever identify dissenting flirting factor
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yeah some clinical studies that try to provide evidence for these hypotheses
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uh and um experiment just came up with the model
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which allowed to switch on and off the guy should bypassing the same patient by
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administering the liquid notice either orally or to guess trust me on separate days
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and what has been found that there's a big difference in got home in response especially to g. l. p. one and p. y.
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y. can see the round full dots represent the response of the
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or we take the empty dots after guest rasta ministrations
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and um oral intake uh leads to an early rapid rise into
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level of this hormones same thing for easily name yeah
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and when we look to the guy scenic response curve we find it
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after oral intake that isn't early rising price email followed by um
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that are below baseline it to three hours after guess trusting administration
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the guy senior goes beat up and then back to baseline
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when we look to the design of the studies be a bit concerned by potential bias namely that investigators did not take
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account the function of the pile overs which limits the or
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kind of interferes with the remnants stomach emptying rate
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and this is very important because i'm actually got home responses colour recreates dependent so
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in this last previous studies experiment there's might have compared apple to peers
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and um maybe the difference the observed in the got form responses only
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related to speed and not really to that forgot hind that hypothesis
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so we came up with another hypothesis and and and that we think that if you would
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put a foot directed to do it in we would observe similar changes in appetite
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because metabolic cement that whole moderate levels compared to orally and very different from guest pasta me
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so we would expect for g. l. p. one for example a super
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possible curve uh end up or do dental and oral administration
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so we came up with a new concept which is similar to the
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previous um models but has an additional root of fruit administration
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post by lower equally directed to to do dinner and we performed a
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study on one patient who was six months of the gastric bypass
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received as standard like with no test of resource drink either orally or by guest ross to me or
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direct to do do you know each route was we repeated uh once again on separate days
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what we found is that speed really doesn't matter do they know and
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or response was quite similar for g. l. p. one and
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p. why why was perennially in very different from guest austin which
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almost did not interfere with the level of this hormones
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however to our own surprise another interesting harmon show the difference response
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it was only the or root that um use the rise and level of g. i.
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p. for this formant to do it in on the guest recruits were quite similar
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when we look at the guy saying they can easily namely curves we could somewhat
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reproduce the results of previous studies of comparing oral and i guess trick uh
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administration and to do the response lies somewhere in between actually more close to
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the guest pasta me administration by a steady rise and i seem yeah
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we also measured appetite my wish all analogue scores and um
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we found that patient felt immediately fall after oral intake
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not for at all for two hours when we put the foot to the remnants stomach and again to do the
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no response lies somewhere in between so it cannot be only
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explained by the um level of got formants maybe
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maybe they should of these studies related to relatively small sample size
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however we are tempted to come up with some potential explanations
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first of all we think that uh adaptation of the ruling about the gastric bypass
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plays an important role this so called enter plus the city which has different manifestations for
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example it's been of sir that there is a hyper play shop l. cells
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after gastric bypass these are the cells that produce g. l. p. one and also shown that there's not
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regulation of glucose transporters can scene that's can images high up take up the ruling pasta productively
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that are important factor to consider is the very fast guess report chanting rate
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just measured by simply graphics studies that half life around three minutes
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which is to super physiological uh interesting on the gentle either of 'em above one hundred k. local wait a minute
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so to sum up with saying based on our findings future trial should include to do
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than all possible recruit afoot administration to account for the entire file rick function
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and a future try study should challenge the kind of forgot terry's by putting more emphasising
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investigating the role of gastric emptying great and willing adaptation and droplets the city
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i would like to thank the support of my mentor provide some market
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bitter also fantastic people contributed to the study which will be published
00:06:14
in upcoming issues the official journal of the american diabetes association thank

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Conference Program

Q&A
J. Pina-Vaz, Basel
17 May 2018 · 10:44 a.m.
Q&A
H. Hoffmann, Basel
17 May 2018 · 10:55 a.m.
Q&A
J. Meyer, Geneva
17 May 2018 · 11:18 a.m.
Q&A
17 May 2018 · 11:26 a.m.
Q&A
S. Hasler, Baden
17 May 2018 · 11:35 a.m.
Q&A
I. Lazaridis, Basel
17 May 2018 · 11:46 a.m.

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