Bipartición de tránsito intestinal, la nueva era de la cirugía metabólica para la diabetes mellitus de tipo 2
DOI:
https://doi.org/10.30944/20117582.88Palabras clave:
diabetes mellitus tipo 2, intestino delgado, tránsito gastrointestinal, procedimientos quirúrgicos, cirugía metabólica, incretinasResumen
Antecedentes. La diabetes mellitus de tipo 2 es el principal reto de salud pública que enfrentamos actualmente, constituye la primera causa de discapacidad y es o está asociada a las principales causas de muerte en nuestro país. En Ciudad de México, se reportó que más del 79 % de los pacientes diabéticos no tienen cifras óptimas de HbA1c (<6,5 %), mientras que el 47 % presentan descontrol importante (HbA1c >9 %). La cirugía metabólica es el mejor tratamiento en términos de remisión, sin embargo, los mecanismos involucrados no son los tradicional- mente considerados.
Objetivo. Ofrecer actualización acerca de los mecanismos involucrados en la remisión de la diabetes mellitus de tipo 2 después de la cirugía metabólica.
Metodos. Se hizo una revisión bibliográfica utilizando las palabras clave en términos MeSH; hasta el 1° de junio del 2018, se encontraron 83 artículos de referencia considerados como pertinentes.
Resultados. La remisión de la diabetes mellitus de tipo 2 lograda por procedimientos quirúrgicos, depende de complejas interacciones entre la microbiota, los ácidos biliares y el epitelio intestinal, más que de procesos ma- labsortivos o restrictivos. La bipartición de tránsito intestinal es una opción quirúrgica basada en los principios fisiológicos responsables en la remisión de la diabetes, y es la más sencilla y segura para el manejo de la diabetes mellitus.
Conclusiones. La cirugía metabólica ofrece mejores tasas de remisión y control de complicaciones de la diabetes tipo 2 al modificar la secreción de enterohormonas, la concentración e interacciones de los ácidos biliares y al modificar la microbiota.
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