Neurotensin, vasoactive intestinal peptide, and Roux-en-Y gastrojejunostomy. Their role in the dumping syndrome
K. R. Sirinek, T. M. O'Dorisio, B. Howe and A. S. McFee
This study evaluated the effect of gastric bypass on the glucose, insulin,
vasoactive intestinal peptide (VIP), neurotensin, and motilin response to
orally administered glucose in eight morbidly obese patients before and
after operation. Preoperatively, all eight patients remained asymptomatic
during an oral glucose tolerance test, which showed glucose intolerance and
hyperinsulinism. Plasma VIP, neurotensin, and motilin remained below
detectable levels for the entire test. At three months following gastric
bypass (21% weight loss), all eight patients became acutely ill during a
repeated oral glucose tolerance test and had the following symptoms: facial
flushing (eight patients), palpitations (eight patients), nausea (seven
patients), abdominal fullness (seven patients), pallor (four patients),
diaphoresis (two patients), vomiting (two patients), and diarrhea (two
patients). Significant release of neurotensin occurred in seven patients
while three patients had release of VIP, further implicating these two
peptides as part of the pathophysiologic spectrum of the "dumping
syndrome."
