Page 117 - Human Bile Acid Metabolism: a Postprandial Perspective

and DCA as shown in Fig. 3, emphasizing the fact that the increase in unconjugated plasma bile acids after DJBL was not due to one bile acid species. We found no changes in the ratio of 12α-hydroxylated/non12α-hydroxylated bile acids (data not shown).
Postprandial Levels of Glucose, Insulin, GLP-1 Cholecystokinin (CCK)
and FGF19
The effects of DJBL on glucose, insulin, GLP-1 and CCK in the studied subjects have been published previously [16,17]. In summary, duodenal lining lowered glucose and CCK within one week and led to increased postprandial AUC of GLP-1 at week 1 and week 24 after DJBL placement (Fig. 4). Insulin levels were not affected. The only bile acid species that consistently correlated with the AUC of GLP-1 on all study days, was fasting DCA: baseline: r = 0.50, p < 0.05*; week 1 after placement: r = 0.56, p < 0.05*; week 24 after placement: r = 0.63, p < 0.01**. No other correlations were detected for bile acid species to AUC, fasting or peak levels of either glucose, CCK or GLP-1 (data not shown).
There were no significant differences in either fasting levels, postprandial plasma 6 course, or postprandial levels of FGF19 at baseline, week 1 or week 24 after DJBL
placement (see Table 1). However, at baseline, there were strong correlations
between peak FGF19 and virtually all bile acids (peak total bile acids r = 0.79,
p < 0.001***; peak total CA, r = 0.78, p < 0.001***; peak total CDCA, r = 0.79, p < 0.001*** and peak total DCA, r = 0.63, p < 0.007*** that were lost after DJBL placement. Likewise, postprandial AUC of FGF19 and AUC of total bile acids correlated (r = 0.84, p < 0.001***) at baseline but not after treatment.
Individual AUCs of CA, CDCA or DCA did not correlate significantly with FGF19 AUC after Bonferroni correction. FGF19 samples at week 0 for timepoint 180 min were missing due to insufficient sample volume.
Discussion
Duodenal lining markedly increases fasting and postprandial levels of unconjugated bile acids 24 weeks after placement of the DJBL. The TGR5 target GLP-1 was higher after 1 and 24 weeks. Initial strong correlations of bile acids
Duodenal-jejunal bypass liner
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