Targeting gastrointestinaI function beyond GLP-1 to control appetite

The gastrointestinal tract plays a key role in the control of appetite and food intake through upper gastrointestinal secretomotor function and release of gut peptides. The therapeutic efficacy of glucagon-like peptide-1 receptor agonists in the treatment of obesity, type 2 diabetes and several other non-communicable diseases linked to the metabolic syndrome, have established the validity of gastrointestinal signals as a target for the regulation of food intake. This review summarizes recent and ongoing research on luminal and systemic approaches to control appetite and food intake by modulating gastrointestinal signals. These modalities include luminal delivery of specific nutrients and tastants to alter gut peptide secretion, influence gastric accommodation or alter the occurrence of interdigestive gastric phase 3. Comparable effects can be achieved by a number of classical pharmaceutical approaches. The majority of studies are limited to short-term studies in healthy controls. Larger scale long-term studies in patient cohorts are now needed to evaluate the efficacy of these modalities to control appetite and food intake.