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One of the characteristic consequences of Roux\u2010en Y gastric bypass is the expedited nutrient delivery to the distal small intestine, where L\u2010cells are abundant and bile acid reabsorption occurs. To examine the role of the distal small intestine in isolation from other components of Roux\u2010en Y gastric bypass, the ileal transposition (IT) surgery has been used in various rat models. IT relocates the distal ileal segment to the upper jejunum distal to the ligament of Treitz without any other alterations in the gastrointestinal anatomy. Therefore, IT exposes the distal ileal tissue to ingested nutrients after a meal faster than the normal condition. Although there is some inconsistency in the effect of IT according to different types of rat models and different types of surgical protocols, IT typically improved glucose tolerance, increased insulin sensitivity and induced weight loss, and the findings were more prominent in obese diabetic rats. Suggested mechanisms for the metabolic improvements after IT include increased L\u2010cell secretion (e.g., glucagon\u2010like peptides and peptide YY), altered bile acid metabolism, altered host\u2013microbial interaction, attenuated metabolic endotoxemia and many others. Based on the effect of IT, we can conclude that the contribution of the distal small intestine to the metabolic benefits of bariatric\/metabolic surgery is quite considerable. By unveiling the mechanism of action of IT, we might revolutionize the treatment for obesity and type\u00a02 diabetes.<\/jats:p>","DOI":"10.1111\/jdi.12444","type":"journal-article","created":{"date-parts":[[2016,3,18]],"date-time":"2016-03-18T11:45:55Z","timestamp":1458301555000},"page":"94-101","source":"Crossref","is-referenced-by-count":20,"title":["Contribution of the distal small intestine to metabolic improvement after bariatric\/metabolic surgery: Lessons from ileal transposition surgery"],"prefix":"10.1111","volume":"7","author":[{"given":"Tae Jung","family":"Oh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea"},{"name":"Department of Internal Medicine Seoul National University College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Ho","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National 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