Epithelial cell turnover is increased in the excluded stomach mucosa after Roux-en-Y gastric bypass for morbid obesity.

Abstract

BACKGROUND:

Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evaluated. This study aims to analyze the mucosal alterations (proliferative status (Ki-67); apoptosis (caspase-3 and BCL-2); hormonal function (gastrin)) in the excluded stomach.

METHODS:

Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 μm thick were examined for immunoexpression using the streptavidin-biotin-peroxidase method.

RESULTS:

The two groups were comparable for age, gender, gastritis, intestinal metaplasia, and Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standard deviation (SD) = 11.7) in the control group and 29.6 (SD = 7.9) in the cases, p = 0.0003. Ki-67 proliferative index in cases (body = 24.7%, antrum = 24.9%) was significantly higher compared to controls (body = 15.0% and antrum = 17.7%), p = 0.002 and 0.01, respectively. Caspase-3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31%), p = 0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions in the control and cases.

CONCLUSIONS:

Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of relevance in long-term follow-up.

• Authors: Adriana V Safatle-Ribeiro, Pedro A Petersen, Dilson S Pereira Filho, Carlos E P Corbett, Joel Faintuch, Robson Ishida, Paulo Sakai, Ivan Cecconello, Ulysses Ribeiro Jr
• Journal: Obesity surgery (Obes Surg) Vol. 23 Issue 10 Pg. 1616-23 (Oct 2013) ISSN: 1708-0428 [Electronic] United States
• PMID: 24022341 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Gastrins
• Ki-67 Antigen
• Caspase 3

Topics

• Adolescent
• Adult
• Aged
• Brazil
• Caspase 3 (metabolism)
• Cell Proliferation
• Double-Balloon Enteroscopy
• Down-Regulation
• Epithelial Cells (pathology)
• Female
• Gastric Bypass
• Gastric Mucosa (microbiology, pathology)
• Gastric Stump (pathology)
• Gastrins (metabolism)
• Gastritis (pathology)
• Helicobacter Infections (pathology)
• Helicobacter pylori (isolation & purification)
• Humans
• Immunohistochemistry
• Ki-67 Antigen (metabolism)
• Male
• Middle Aged
• Obesity, Morbid (microbiology, pathology, surgery)