Microbiota intestinal y cirugía bariátrica
DOI:
https://doi.org/10.47196/diab.v49i1.195Palabras clave:
obesidad, cirugía bariátrica, diabetes tipo 2, microbiotaResumen
En los últimos años, el estudio de la microbiota intestinal emergió como un nuevo factor ambiental en la patogenia de la obesidad y la diabetes tipo 2 (DM2), enfermedades complejas, heterogéneas, crónicas y progresivas. Los tratamientos convencionales de la obesidad mórbida fracasan, y actualmente se considera a la cirugía bariátrica como el único tratamiento efectivo de la obesidad severa, definida como IMC >40 ó IMC >35 asociado a comorbilidades. Los mecanismos de restricción y malabsorción fueron propuestos inicialmente como responsables del descenso de peso y la mejoría metabólica observados luego de la cirugía bariátrica, sin embargo, no pueden explicar la rápida remisión de la DM2 con el procedimiento quirúrgico. Aunque se investigan intensamente, no se conocen con exactitud los mecanismos causales de los beneficios metabólicos. Se postulan los siguientes: cambios neuroendocrinos asociados al redireccionamiento del flujo de nutrientes, modificaciones del vaciamiento gástrico y motilidad intestinal, cambios en la conducta alimentaria, remodelamiento del asa de Roux, alteración de la circulación entero-hepática de ácidos biliares, gluconeogénesis intestinal y modificaciones en la microbiota intestinal. Se considera a la microbiota un eslabón entre la dieta rica en grasas, la inflamación sistémica y la homeostasis de la glucosa. Algunos estudios en animales y en humanos sugieren que los cambios en la composición de la microbiota pueden contribuir a los beneficios metabólicos observados luego del bypass gástrico en-Y-de Roux (BGYR).
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