Abstract:
:Bariatric surgery (e.g. Roux-en-Y gastric bypass (RYGB)) has proven the most effective way of achieving sustainable weight losses and remission of type 2 diabetes (T2D). Studies indicate that the effectiveness of RYGB is mediated by an altered gastrointestinal tract anatomy, which in particular favours release of the gut incretin hormone glucagon-like peptide-1 (GLP-1). The EndoBarrier gastrointestinal liner or duodenal-jejunal bypass sleeve (DJBS) is an endoscopic deployable minimally invasive and fully reversible technique designed to mimic the bypass component of the RYGB. Not only GLP-1 is released when nutrients enter the gastrointestinal tract. Cholecystokinin (CCK), secreted from duodenal I cells, elicits gallbladder emptying. Traditionally, bile acids are thought of as essential elements for fat absorption. However, growing evidence suggests that bile acids have additional effects in metabolism. Thus, bile acids appear to increase GLP-1 secretion via activation of the TGR5 receptor on the intestinal L cell. Recently FXR receptors were postulated to contribute to GLP-1 secretion too. Furthermore, metformin has been shown to increase circulating GLP-1 levels but although the exact mechanism is not fully elucidated it may involve metformin-induced inhibition of bile acid reuptake from the small intestines. Small-sized studies reported varying degrees of weight loss and, in some, improvement of glucose metabolism. Therefore, the objectives of this thesis were to collect existing information on the DJBS in order to evaluate clinical efficacy and safety (study I and II). Furthermore, since the endocrine impact of the DJBS is not fully elucidated, and DJBS is expected to mimic RYGB, we investigated postprandial metabolic changes following 26 weeks of DJBS treatment in ten obese subjects with normal glucose tolerance (NGT) and nine matched patients with T2D (study III). Finally, we studied the single and combined effects of CCK induced gallbladder emptying and single-dose metformin on human GLP-1 secretion in ten healthy subjects (study IV). We hypothesized that metformin-induced GLP-1 secretion - at least partly - would be dependent on gallbladder emptying and the presence of bile acids in the gut. DJBS appears to lead to moderate weight losses in obese subjects compared to diet or lifestyle modifications (study II). DJBS had insignificant and small effects (compared to diet) on glycaemic regulation. Adverse events consisted mainly of mild-to-moderate transient dyspepsia. Nearly 20% (n = 66) of DJBS treated subjects experienced a serious adverse event (e.g. gastrointestinal bleeding or device migration), which resulted in early device removals. No deaths or liver abscesses were reported following DJBS treatment. In our own study III we found similar, moderate weight losses as in study II. GLP-1 and PYY concentrations increased in patients with T2D (not NGT subjects) after implantation. DJBS had no or minor effects on postprandial levels of glucose, insulin, C-peptide, glucagon, GIP, CCK or gastrin. Food intake decreased in parallel with an increased sensation of satiety in obese NGT subjects, but were transient. Dyspeptic episodes occurred in nearly all participants. Five devices (21%) were explanted early due to abdominal pain, and few changes of on-going antidiabetic medication were made. Finally, study IV showed that both CCK-induced gallbladder emptying and metformin alone elicited significant GLP-1 responses that were additive upon combination. Moreover, we saw significant PYY and short-lasting glucose-dependent insulinotropic polypeptide (GIP) responses following gallbladder emptying. In conclusion, in spite of increased GLP-1 responses in patients with T2D and a modest weight loss, DJBS had no effect on postprandial glucose metabolism, and therefore no patient with T2D achieved disease remission. Based on our results, we cannot recommend DJBS to be implemented as a standard of medical care management of obese patients with T2D. Future larger trials may lead to different conclusions. In addition, the observed gut hormone responses following CCK-induced gallbladder emptying and metformin, make suggest that bile acid release into the small intestines with subsequent TGR5 and FXR involvement contributes to stimulation of GLP-1 secretion and, therefore, that metformin's mode of action encompasses both bile acid-dependent and independent stimulation of gut hormone secretion.
journal_name
Dan Med Jjournal_title
Danish medical journalauthors
Rohde Usubject
Has Abstractpub_date
2016-11-01 00:00:00issue
11issn
2245-1919pii
B5309journal_volume
63pub_type
杂志文章,评审abstract:INTRODUCTION:This study explored whether health-related quality of life (HRQOL) changes following Roux-en-Y gastric bypass surgery were associated with identifiable socio-demographic or clinical characteristics, and it examined the impact on health outcomes of changes in the Danish criteria for bariatric surgery. MATE...
journal_title:Danish medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:2014-07-01 00:00:00
abstract:INTRODUCTION:This article presents the treatment results of 320 consecutive patients with malignant haematological diagnoses admitted to a tertiary intensive care unit at a Danish University hospital over a six-year period (2005-2010). With reference to international publications, we describe the development in treatme...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-03-01 00:00:00
abstract:INTRODUCTION:Atrial fibrillation (AF) is a cardiac epidemic. In this study, we aimed to describe the causes of hospital-isation in an AF population over time and to study how different AF treatment strategies affected hospitalization. MATERIAL AND METHODS:This was an observational study in which long-term follow-up da...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:The Danish Adult Diabetes Database (DADD) annually reports a quality indicator for lipid-lowering treatment of type 2 diabetes mellitus (T2DM) patients. This retrospective cohort study aims to A) investigate the reasons for inadequate or lacking lipid-lowering treatment and to B) assess the validity of the...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2018-09-01 00:00:00
abstract:INTRODUCTION:Treatment of infections in neonates with gentamicin is a balance between optimising bactericidal effect and minimising adverse effects. Previously, at the Neonatal Intensive Care Unit (NICU) at Kolding Hospital, Denmark, neonates suspected of having infections were treated daily with gentamicin 5 mg/kg for...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-06-01 00:00:00
abstract:INTRODUCTION:With the increasing use of cross-sectional imaging, the incidence of non-symptomatic pancreatic cystic neoplasms is increasing. Surgical management of pancreatic cystic neoplasms possess significant risks of perioperative morbidity and mortality. Our aim was to evaluate endoscopic ultrasound (EUS)-guided a...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-08-01 00:00:00
abstract:INTRODUCTION:Microbiological documentation of one uropathogenic bacterium in significant numbers in urine from patients with typical symptoms is the gold standard for diagnosing urinary tract infection (UTI). Cleaning before collecting midstream urine (MSU) is reported not to reduce the risk of contaminating the sample...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-06-01 00:00:00
abstract::Hip dysplasia and hip joint deformities in general are recognized as possible precursors of osteoarthritic development. Early and correct identification of hip dysplasia is important in order to offer timely joint preserving treatment. In the contemporary literature, several controversies exist, and some of these were...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2012-06-01 00:00:00
abstract:INTRODUCTION:Tonsillectomy may be performed by several methods. It is continuously being discussed which method is preferable with regard to postoperative haemorrhage, pain, activity and nutrition. MATERIAL AND METHODS:The present study is a prospective non-randomized study of tonsillectomy. It included 198 patients a...
journal_title:Danish medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract:INTRODUCTION:The aim of this study was to compare cancer mortality among migrant patients with cancer mortality in Danish-born patients. MATERIAL AND METHODS:This was a historical prospective cohort study. All non-Western migrants (n = 56,273) who were granted a right to residency in Denmark between 1 January 1993 and...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-06-01 00:00:00
abstract:INTRODUCTION:Adjuvant treatment of early-stage breast cancer has been associated with bone loss in randomised trials, but evidence from unselected populations is needed. In a single-center study, we assessed the annual percentage change in bone mineral density (∆BMDt) and risk of osteoporosis from two to five years aft...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-10-20 00:00:00
abstract:INTRODUCTION:The prevalence of children and adolescents with overweight and obesity has tripled over the past 30 years. One in five children in Denmark is overweight, a condition which is accompanied by serious medical and psychosocial complications. So far, an overview of the Danish treatment of childhood overweight a...
journal_title:Danish medical journal
pub_type: 杂志文章,多中心研究
doi:
更新日期:2016-09-01 00:00:00
abstract:INTRODUCTION:This is a systematic review of existing literature on the diagnostic modalities and treatment of traumatic abdominal wall hernia caused by bicycle handlebar injury in children. METHODS: A systematic literature search was conducted covering incidents involving children below 17 years of age. Data were extr...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:High levels of pro-inflammatory cytokines are present in the gut of patients with inflammatory bowel disease (IBD) and have a crucial role in the dysfunction of mucosal homeostasis. Caudal-related homeobox transcription factor 2 (CDX2) is an essential regulator of intestinal epithelium homeostasis. When expr...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2014-03-01 00:00:00
abstract:INTRODUCTION:Due to disagreement on optimal timing of inguinal hernia repair in children, we explored how Danish surgeons plan repair in children at different ages and with different symptoms. METHODS:A validated questionnaire on timing of inguinal hernia repair in children was sent to all surgeons performing paediatr...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-12-22 00:00:00
abstract:INTRODUCTION:Volvulus is an axial twist of any part of the gastrointestinal tract along its mesentery. If it goes unattended, it will cause bowel obstruction and bowel ischaemia with gangrene and perforation. The primary treatment is endoscopic desufflation, but the place for elective surgery is controversial. Volvulus...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-07-01 00:00:00
abstract:INTRODUCTION:Transferring a patient from one health-care sector to another implies a risk of medication errors. It is of interest to evaluate whether a specialist in clinical pharmacy is beneficial for the patients in the emergency departments (ED). The aim of the present study was to report the incidence, categories a...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-11-01 00:00:00
abstract:INTRODUCTION:Psychiatric disorders are common among patients with irritable bowel syndrome (IBS) which may make a psychiatric evaluation appropriate. The Hospital Anxiety and Depression Scale (HADS) has been recommended internationally for screening. The Common Mental Disorder Questionnaire (CMDQ) is a novel Danish ins...
journal_title:Danish medical journal
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2014-02-01 00:00:00
abstract::Sudden Cardiac Death (SCD) in the young (aged 1-35 years), although presumably rare, is always a tragic and devastating event often occurring in apparently healthy persons. Through the last decades, research have been undertaken to estimate the incidence rate and underlying causes of these deaths. However, because aut...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2012-02-01 00:00:00
abstract:INTRODUCTION:The health authorities have recommended that face-to-face consultations be substituted by telephone consultations to reduce the risk of virus transmission in out-patient clinics during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the present study was to assess the frequency of such telepho...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2020-06-23 00:00:00
abstract:INTRODUCTION:Pain and distress during minor hospital-related procedures is a familiar problem in many children. Inadequate relief of children's procedural pain and distress not only affects the experience of the children and their parents, but also adversely impacts procedural success. We aimed to review the safety and...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2013-06-01 00:00:00
abstract:INTRODUCTION:Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the litera...
journal_title:Danish medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2014-05-01 00:00:00
abstract:INTRODUCTION:Patients living alone or having a low socioeconomic status are likely to quit cardiac rehabilitation. We aimed to compare patients being offered extended rehabilitation (ERP) with those being offered standard rehabilitation (SRP) as concerns 1) attendance rates and 2) achievement of treatment goals at 12 m...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-03-01 00:00:00
abstract:INTRODUCTION:The prevalence of sarcopenia varies extensively depending on the definitions and studied populations. The aim of this study was to assess the prevalence of sarcopenia in a Danish geriatric out-patient population using criteria from the European Working Group on Sarcopenia (EWGSOP). METHODS:Patients referr...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2018-06-01 00:00:00
abstract::Both non-pathological psychological stress states and mental disorders are associated with molecular, cellular and epidemiological signs of accelerated aging. Oxidative stress on nucleic acids is a critical component of cellular and organismal aging, and a suggested pathogenic mechanism in several age-related somatic ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-07-01 00:00:00
abstract:INTRODUCTION:Colorectal cancer is a common malignant disease, caused by different aetiologies and molecular pathways. Heterogeneous results have been published regarding the association of microsatellite instability and clinicopathological features. The aim of this study was to compare clinicopathological features of m...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2016-02-01 00:00:00
abstract:INTRODUCTION:Surveying sexual behaviour of the general population serves to identify key points of preventive interventions, monitor the effect and interpret changes in patterns of disease. Validated questionnaires describing sexual behaviour can be adapted to some extent from other countries, but national adaption, re...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2013-01-01 00:00:00
abstract::Excessive health anxiety, still designated as hypochondriasis in ICD-10, refers to worries and anxiety about harbouring serious illness. It is common in both primary and secondary health care with prevalence rates up to 9% and causes great suffering for the individual as well as high health care costs when untreated. ...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2017-05-01 00:00:00
abstract:INTRODUCTION:From the clinical forensic examination reports made at the Department of Forensic Medicine, the University of Copenhagen, in 2007 concerning rape, attempted rape and sexual assault (RAS), information about the assault, including both violence and the perpetrator's line of sexual action was extracted, analy...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2014-09-01 00:00:00
abstract:INTRODUCTION:The aim of this study was to assess the complication rates of total thyroidectomy in a regional hospital setting in Denmark for permanent hypoparathyroidism, recurrent laryngeal nerve palsy and post-operative bleeding. Furthermore, the long-term outcomes in the management of hypoparathyroidism were investi...
journal_title:Danish medical journal
pub_type: 杂志文章
doi:
更新日期:2015-11-01 00:00:00