A new study by Prof. Vivek Kumbhari and his team shows a potentially new weight loss method: targeting the gastric mucosa with GMD.
The gastric mucosa is an endocrine organ that regulates satiation pathways by expression of orexigenic and anorexigenic hormones. Vertical sleeve gastrectomy (VSG) excludes gastric mucosa and reduces gastric volume. This study aimed to investigate the independent effects of altering gastric mucosa on obesity and its related comorbidities.
GMD resulted in significant reductions in body weight, visceral and subcutaneous adipose tissue, and hepatic steatosis as well as an improvement in lipid metabolism. It also resulted in significant reductions in food intake and intestinal malabsorption of free fatty acids, both contributing to improved body composition and metabolic profile. Thus, GMD resulted in a significant reduction in serum palmitate levels as well as an increase in serum and liver bile acid levels, known to alter glucose and lipid metabolism. Similar changes were noted when VSG rats were compared with sham surgery rats.
As a result, devitalization of gastric mucosa, independent of altering gastric volume, was able to reduce obesity-related comorbidities. The gastric mucosa may be a potential target for treating obesity and its associated comorbidities.
As shown above, GMD rats had a lower body weight and reduced intrabdominal adiposity compared with sham surgery rats. The morphologic findings at 8 weeks postoperative were compared with those of sham surgery. GMD rats appeared smaller in size compared with sham surgery rats. Additionally, GMD rats had grossly diminished adiposity of the greater omentum and surrounding intestinal organs.
Although the exact mechanisms behind intestinal malabsorption and other metabolic parameters are still to be elucidated, these observed effects have important translational relevance in the fight against obesity and its related comorbidities.
This current work is innovative by identifying the gastric mucosa as a critical regulator of obesity and its metabolic effects. The key observation is that GMD produces a reduction in body weight, reduction in visceral adiposity, improved serum lipid, and glucose profiles, and reduced liver lipid accumulation content – all pivotal facets of any metabolic therapy.
Although the gastric mucosa has the ability to regenerate, the advantage of an endoscopic procedure is the ease at which repeated interventions can be performed. Therefore, it appears that altering gastric mucosa should be considered as a new possible target for the development of a less-invasive intervention in the treatment of obesity and metabolic disease.
Dr. Vivek Kumbhari and his colleague, Dr. Mouen Khashab are hosting the HITEC (Hopkins International Therapeutic Endoscopy Course) on May 2-4, 2018, in Baltimore, USA. This unique event will showcase everything related to therapeutic endoscopy including a day dedicated to bariatric endoscopy. Live cases, lectures, and hands-on training will be demonstrated by renowned endoscopists from all over the world.