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

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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.

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Acknowledgments

The authors thank Thaise Yumie Tomokani and Bruna Souza de Quevedo for their technical assistance. This work was supported by a grant from the Foundation of Support to the Research of the State of São Paulo (FAPESP, no. 06/537414).

Conflict of Interest

The authors of this manuscript—Adriana V. Safatle-Ribeiro, M.D., PhD; Pedro A. Petersen, M.D.; Dilson S. Pereira Filho, M.D.; Carlos E. P. Corbett, M.D., PhD; Joel Faintuch, M.D., PhD; Robson Ishida, M.D.; Paulo Sakai, M.D., PhD; Ivan Cecconello, M.D., PhD; and Ulysses Ribeiro Jr. M.D., PhD—have no conflict of interest.

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Authors and Affiliations

  1. Departments of Gastroenterology and Pathology, University of São Paulo School of Medicine, Rua Treze de Maio, 1954, Cj. 54, São Paulo, SP, Brazil, 01327-002

    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.

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  1. Adriana V. Safatle-Ribeiro
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  2. Pedro A. Petersen
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Correspondence to Adriana V. Safatle-Ribeiro.

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Safatle-Ribeiro, A.V., Petersen, P.A., Pereira Filho, D.S. et al. Epithelial Cell Turnover Is Increased in the Excluded Stomach Mucosa After Roux-en-Y Gastric Bypass for Morbid Obesity. OBES SURG 23, 1616–1623 (2013). https://doi.org/10.1007/s11695-013-0975-2

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