Epithelial Cell Turnover Is Increased in the Excluded Stomach Mucosa After Roux-en-Y Gastric Bypass for Morbid Obesity

• DOI: 10.1007/s11695-013-0975-2
• Publication Date: 2013-05-01T03:48:27Z
• Authors: Adriana V. Safatl...; Pedro A. Petersen; Dilson S. Pereira...; Carlos E. P. Corbett; Joel Faintuch; Robson Ishida; Paulo Sakai; Ivan Cecconello; Ulysses Ribeiro
• Keywords: Adult; Adolescent; Gastric Bypass; Down-Regulation; Helicobacter Infections; 03 medical and health sciences; 0302 clinical medicine; Gastric Stump; Gastrins; Humans; Aged; Cell Proliferation; Double-Balloon Enteroscopy; 2. Zero hunger; Helicobacter pylori; Caspase 3; Epithelial Cells; Immunohistochemistry; 3. Good health; Ki-67 Antigen; Gastric Mucosa; Gastritis; Female; Brazil

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.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.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.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.