Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity.
OBJECTIVE
Mucosal cytokines may be involved in the process of gastric bacterial contamination that may occur after Roux-en-Y bypass for morbid obesity in both gastric chambers, with inflammation and gastritis mostly in the excluded stomach.


METHODS
A prospective observational study in a homogeneous population with nonspecific complaints.


METHODS
Outpatient clinic of a large, public, academic hospital.


METHODS
Subjects (n = 37; 26 [70.3%] female; mean +/- SD age, 42.4 +/- 9.9 years) seen a mean +/- SD of 7.3 +/- 1.4 years after Roux-en-Y gastric bypass and nonoperated on morbidly obese control subjects (n = 10; 7 [70%] female; mean +/- SD age, 44.0 +/- 8.9 years).


METHODS
Enteroscopy was performed to collect samples for cytokine assays and bacteriologic studies.


METHODS
Concentrations of tumor necrosis factor alpha and transforming growth factor beta in the gastric mucosa of both chambers in patients undergoing Roux-en-Y gastric bypass and correlation with bacterial overgrowth and Helicobacter pylori infection.


RESULTS
High microbial counts (>10(5) colony-forming units per milliliter) were detected in 22 (59.5%) and 7 (18.9%) of the 37 samples from the functional pouch and excluded reservoir, respectively; and H pylori investigation was positive in 6 of 37 samples (16.2%). The tumor necrosis factor alpha concentration (mean +/- SD, 2.1 +/- 1.9 pg/g of protein) and the transforming growth factor beta concentration (mean +/- SD, 24.2 +/- 12.8 pg/g of protein) in the excluded stomach, but not in the proximal pouch, were elevated with regard to the corpus or antrum of controls, and correlation with bacterial overgrowth and with H pylori infection was demonstrated.


CONCLUSIONS
Overexpression of tumor necrosis factor alpha and transforming growth factor beta occurred in the distal stomach, positive cytokine correlation with microbial invasion by H pylori and nonspecific germs was seen, and further studies addressing phenotypic and genotypic changes of gastric mucosa are recommended.
Faintuch
Joel
J
Department of Gastroenterology, Hospital das Clinicas, Avenida Eneias C Aguiar 225, ICHC 9th floor, Sao Paulo SP 05403900, Brazil. jfaintuch@hcnet.usp.br
Ishida
Robson K
RK
Jacabi
Mioko
M
Ribeiro
Adriana S
AS
Kuga
Rogerio
R
Sakai
Paulo
P
Barbeiro
Hermes V
HV
Barbeiro
Denise F
DF
Soriano
Francisco G
FG
Cecconello
Ivan
I
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D005753:Gastric Mucosa / Q000378:metabolism* / Q000382:microbiology; D018530:Gastric Stump; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000378:metabolism* / Q000382:microbiology / Q000601:surgery; D011446:Prospective Studies; D016212:Transforming Growth Factor beta / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D016212:Transforming Growth Factor beta; D014409:Tumor Necrosis Factor-alpha