Impact of intestinal resections on the secretion of gastrointestinal hormones.

BACKGROUND AND AIMS: Intestinal resection changes nutrient exposure of enteroendocrine cells and may alter gastrointestinal hormone secretion. This study aims to characterize basal and postprandial gastrointestinal hormone profiles across distinct remnant intestinal anatomies after intestinal resection.

METHODS

In this single-center, cross-sectional study, 31 patients were grouped according to remnant anatomy: end-jejunostomy (Group 1A, n = 8), ileostomy (1B, n = 8), jejuno-colonic anastomosis (2, n = 7) and jejuno-ileal anastomosis (3, n = 8) and compared with 8 healthy controls. Concentrations of gastrin, CCK, GIP, neurotensin, GLP-1, GLP-2 and PYY were measured before and for 240 min after a standardized meal.

RESULTS

Basal gastrin was 6-fold higher in 1A than in controls and correlated inversely with small bowel length. CCK AUC and iAUC were increased in groups 1A and 2 versus controls and correlated negatively with both small bowel and colon length. Neurotensin AUC and iAUC were lowest in 2. GLP-1 and GLP-2 responses were greatest in 3, with GLP-1 AUC 56% higher than in 1A, and GLP-2 AUC approximately twofold higher than in controls. PYY was reduced in 1A versus controls but markedly increased in groups 2 and 3 versus 1A and controls. Basal PYY correlated negatively with small bowel length and positively with colon length. GIP concentrations did not differ across groups.

CONCLUSION

Remnant intestinal anatomy is a major determinant of hormone profiles after intestinal resection. Preservation of terminal ileum and/or colon is associated with enhanced distal L cell secretion, consistent with an "ileal brake" phenotype, whereas short jejunum without distal bowel is associated with hypergastrinaemia and increased CCK secretion.

CLINICALTRIALS: gov no: NCT07235670.