Warum Patienten nach bariatrischen Operationen Gewicht abnehmen

 

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Zusammenfassung

Die Zunahme des krankhaften Übergewichtes mit seiner assoziierten Morbidität und Mortalität ist in Deutschland und weltweit ein großes sozial-ökonomisches Problem. Zurzeit stellt die bariat­rische Chirurgie die effektivste Therapiemethode mit signifikantem und andauerndem Gewichtsverlust dar. Von den verschiedenen bariatrischen Operationsverfahren wird der Roux-en-Y-Magenbypass weltweit mit am häufigsten durchgeführt. Viele der zugrundeliegenden Mechanismen der Magenbypass-Chirurgie und der Gründe für seine Überlegenheit gegenüber anderen Therapieoptionen sind allerdings noch unklar. Es deutet vieles darauf hin, dass entgegen ursprünglicher Annahmen eine Malabsorption oder eine reduzierte Nahrungsaufnahme durch Restriktion keine oder nur eine untergeordnete Rolle für die Reduktion des Körpergewichtes spielen. Stattdessen scheint der Magenbypass die Physiologie der Gewichts­regulation und des Essverhaltens nachhaltig zu verändern. Die Gewichtsabnahme nach Magenbypass scheint auf komplexen neurophysiologischen und neuro-endokrinologischen Mechanismen zu beruhen, in denen veränderte Spiegel ­verschiedener gastrointestinaler Hormone eine wichtige Rolle einnehmen. Dieser Artikel soll ­einen Überblick über das derzeitige Wissen zur Regulation von Körpergewicht und Essverhalten durch gastrointestinale Hormone geben und ­beleuchten, wie die Magenbypass-Operation in diese Mechanismen eingreift. 

Abstract

The obesity epidemic is in Germany as well as worldwide a major health problem which is associated with increased morbidity and mortality. Bariatric surgery is currently the most effective therapy for significant and sustained weight loss. The most common form of bariatric surgery worldwide is Roux-en-Y gastric bypass surgery. The underlying mechanisms behind the superiority of this procedure are unclear and remain to be elucidated, but recent findings suggest that gastrointestinal hormones play an important role rather than malabsorption or restriction. It appears that gastric bypass surgery alters the physiology of weight regulation and eating behaviour in patients who have undergone the procedure. Gastrointestinal hormones have recently been found to be an important element in the physiol­ogy of appetite regulation due to the signals from the periphery to the brain. It is the purpose of this article to review the current knowledge about the regulation of body weight and eating behaviour by gastrointestinal hormones and how their levels are altered after bariatric surgery. 

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Dr. Marco Bueter

Imperial College London · Hammersmith Hospital · Department for Investigative Medicine

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