The release of GLP-1 and ghrelin, but not GIP and CCK, by glucose is dependent upon the length of small intestine exposed

Previous observations suggest that glucagon-like peptide-1 (GLP-1) is released into the bloodstream only when dietary carbohydrate enters the duodenum at rates that exceed the absorptive capacity of the proximal small intestine to contact GLP-1 bearing mucosa in more distal bowel. The aims of this study were to determine the effects of modifying the length of small intestine exposed to glucose on plasma concentrations of GLP-1 and also glucose-dependent insulinotropic peptide ( GIP), insulin, cholecystokinin (CCK) and ghrelin, and antropyloric pressures. Glucose was infused at 3.5 kcal/min into the duodenum of eight healthy males ( age 18-59 yr) over 60 min on the first day into an isolated 60-cm segment of the proximal small intestine (short-segment infusion); on the second day, the same amount of glucose was infused with access to the entire small intestine (long-segment infusion). Plasma GLP-1 increased and ghrelin decreased ( P < 0.05 for both) during the long-, but not the short-, segment infusion. By contrast, increases in plasma CCK and GIP did not differ between days. The rises in blood glucose and plasma insulin were greater during the long- than during the short- segment infusion ( P < 0.05). During the long- but not the short- segment infusion, antral pressure waves (PWs) were suppressed ( P < 0.05). Isolated pyloric PWs and basal pyloric pressure were stimulated on both days. In conclusion, the release of GLP- 1 and ghrelin, but not CCK and GIP, is dependent upon > 60 cm of the intestine being exposed to glucose.