The Phantom Satiation Hypothesis of Bariatric Surgery

Research output: Contribution to journalArticlepeer-review

Abstract

The excitation of vagal mechanoreceptors located in the stomach wall directly contributes to satiation. Thus, a loss of gastric innervation would normally be expected to result in abrogated satiation, hyperphagia, and unwanted weight gain. While Roux-en-Y-gastric bypass (RYGB) inevitably results in gastric denervation, paradoxically, bypassed subjects continue to experience satiation. Inspired by the literature in neurology on phantom limbs, I propose a new hypothesis in which damage to the stomach innervation during RYGB, including its vagal supply, leads to large-scale maladaptive changes in viscerosensory nerves and connected brain circuits. As a result, satiation may continue to arise, sometimes at exaggerated levels, even in subjects with a denervated or truncated stomach. The same maladaptive changes may also contribute to dysautonomia, unexplained pain, and new emotional responses to eating. I further revisit the metabolic benefits of bariatric surgery, with an emphasis on RYGB, in the light of this phantom satiation hypothesis.

Original languageEnglish (US)
Article number626085
JournalFrontiers in Neuroscience
Volume15
DOIs
StatePublished - Feb 1 2021

Keywords

  • appetite
  • autonomic nervous system
  • gastroenterology
  • neurology
  • nociception
  • vagotomy
  • vagus

ASJC Scopus subject areas

  • Neuroscience(all)

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