title: Jejunoileal bypass changes the duodenal cholecystokinin and somatostatin cell density.
abstract: BACKGROUND
  In obese patients, jejunoileal bypass (JIB) has been used to induce weight reduction. Changes in the neuroendocrine system may be affected by the JIB-operation, because the proximal small intestinal mucosa has a rich supply of endocrine cells and peptidergic nerves.
  
  
  METHODS
  In 37 obese patients operated with JIB 1-30 years ago, small intestinal biopsies were taken at the duodeno-jejunal flexure, proximal to the anastomosis and from 5 unoperated obese persons and 20 normal weight patients. The tissue specimens were processed for immunocytochemical demonstration of cells/nerves containing: gastrin, cholecystokinin (CCK), secretin, gastric inhibitory peptide (GIP), motilin, somatostatin, serotonin, glicentine, peptide YY (PYY), neurotensin, vasoactive intestinal peptide (VIP), substance P, neuropeptide Y (NPY) and galanin. The number of different endocrine cell-types were counted per unit length of mucosa, and the density of the peptidergic nerves was assessed semiquantitatively according to a schematic scale.
  
  
  RESULTS
  JIB-patients had an increased density of CCK and somatostatin cells in the duodenal mucosa. The CCK cells displayed a changed reaction pattern, with a greater cell number reacting with an antiserum directed towards a non-amidated mid-sequence of procholecystokinin compared with the other groups. In obese unoperated patients, the density of PYY and secretin cells was decreased compared with the JIB-patients and the density of the GIP cells compared with both other groups.
  
  
  CONCLUSIONS
  JIB induces an up-regulation of somatostatin and CCK precursor-containing cells in the duodenal mucosa. The time duration after the JIB did not seem to influence the results.
authors.affiliation: Department of Internal Medicine, Ryhov's Hospital, Jönköping, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Ockander
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hedenbro
authors.forename: Jens F
authors.initials: JF
authors.lastname: Rehfeld
authors.forename: Kristina
authors.initials: K
authors.lastname: Sjölund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D002766:Cholecystokinin / Q000032:analysis* / Q000378:metabolism; D004386:Duodenum / Q000378:metabolism / Q000473:pathology*; D019858:Enteroendocrine Cells / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005755:Gastrins / Q000032:analysis / Q000378:metabolism; D006728:Hormones / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D007581:Jejunoileal Bypass / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000473:pathology* / Q000601:surgery*; D013004:Somatostatin / Q000032:analysis* / Q000378:metabolism; D019864:Somatostatin-Secreting Cells / Q000378:metabolism / Q000473:pathology; D013997:Time Factors
chemical_list: D005755:Gastrins; D006728:Hormones; D013004:Somatostatin; D002766:Cholecystokinin