- 作者：Maurizio Bevilacqua ; Ligia J. Dominguez ; Velella Righini ; Tarcisio Vago ; Diego Foschi ; Fabio Corsi ; Emilio Trabucchi ; Enrica Chebat ; Maria Del Carmen Borghi ; Gian Marco Diana ; Massimo Barrella ; Mario
- 刊名：Surgery
- 出版年：2010
- 出版时间：May 2010
- 年：2010
- 卷：147
- 期：5
- 页码：655-661
- 全文大小：300 K
Background
It is generally considered that changes in serum phosphate levels do not alter parathyroid hormone (PTH) secretion in the absence of concomitant changes in ionized serum calcium level in humans. An acute rise in PTH was shown after phosphate administration by intraduodenal gavage in rats. We aimed to study gastrin, phosphate, PTH, ionized calcium (iCa), and blood pH responses to oral peptones in morbidly obese patients before and after roux-en-Y gastric bypass (RYGB) surgery.Methods
These parameters were evaluated in response to an oral peptone load in 24 (18 male and 6 female) obese subjects before and 6 months after RYGB surgery. In 12 gastric bypass patients, we also evaluated PTH and phosphate after peptones plus aluminum hydroxide administration to suppress phosphate absorption.
Results
Before RYGB, peptones increased gastrin (P < .001), and decreased iCa (P < .01) without changes in PTH or pH. Both phosphate and PTH markedly increased after RYGB with the peptones oral load (P < .01), without changes in pH, iCa, or gastrin. There was a significant, direct relationship between the increase of phosphate and the increase of PTH in the patients treated with aluminum hydroxide (r2 = 0.78; P < .0001).
Conclusion
Rapid delivery of peptones in the jejunum in bypassed obese patients results in a significant rise in phosphate and PTH, in the absence of changes of other PTH regulators, possibly mediated by a signaling from the gastrointestinal tract. RYGB patients provide an opportunity to study the control of PTH secretion, with potential relevant clinical implications.