title: 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.affiliation: 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, adrisafatleribeiro@terra.com.br.
authors.forename: Adriana V
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Petersen
authors.forename: Dilson S
authors.initials: DS
authors.lastname: Pereira Filho
authors.forename: Carlos E P
authors.initials: CE
authors.lastname: Corbett
authors.forename: Joel
authors.initials: J
authors.lastname: Faintuch
authors.forename: Robson
authors.initials: R
authors.lastname: Ishida
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D053148:Caspase 3 / Q000378:metabolism; D049109:Cell Proliferation; D058582:Double-Balloon Enteroscopy; D015536:Down-Regulation; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D015390:Gastric Bypass; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D018530:Gastric Stump / Q000473:pathology*; D005755:Gastrins / Q000378:metabolism; D005756:Gastritis / Q000473:pathology; D016481:Helicobacter Infections / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000382:microbiology / Q000473:pathology* / Q000601:surgery
chemical_list: D005755:Gastrins; D019394:Ki-67 Antigen; D053148:Caspase 3
references.citation: Cancer Detect Prev. 2000;24(1):13-23
references.pmid: 10757119
references.citation: Obes Surg. 1998 Jun;8(3):289-95
references.pmid: 9678196
references.citation: Obes Surg. 2010 Feb;20(2):181-7
references.pmid: 19705207
references.citation: Surg Obes Relat Dis. 2007 Nov-Dec;3(6):644-7
references.pmid: 17950044
references.citation: J Gastrointest Surg. 2005 Jan;9(1):121-31
references.pmid: 15623453
references.citation: Aust N Z J Surg. 1997 Aug;67(8):580-2
references.pmid: 9287934
references.citation: Curr Surg. 2003 Sep-Oct;60(5):521-3
references.pmid: 14972217
references.citation: Ann Intern Med. 1991 Dec 15;115(12):956-61
references.pmid: 1952493
references.citation: Zhonghua Zhong Liu Za Zhi. 2006 May;28(5):357-60
references.pmid: 17045000
references.citation: Surg Obes Relat Dis. 2006 Nov-Dec;2(6):651-5
references.pmid: 17138237
references.citation: Dig Dis. 1998 May-Jun;16(3):159-68
references.pmid: 9618135
references.citation: Obes Surg. 2007 Jun;17(6):752-8
references.pmid: 17879574
references.citation: Arch Surg. 2007 Oct;142(10):942-6
references.pmid: 17938306
references.citation: Obes Surg. 2006 Jul;16(7):932-4
references.pmid: 16839497
references.citation: J Am Diet Assoc. 2010 Apr;110(4):571-84
references.pmid: 20338283
references.citation: J Clin Gastroenterol. 1991 Apr;13(2):191-4
references.pmid: 1843447
references.citation: J Gastrointest Surg. 2011 Jan;15(1):71-80
references.pmid: 21061177
references.citation: Obes Surg. 2005 Mar;15(3):423-7
references.pmid: 15826480
references.citation: J Gastroenterol. 2005 Apr;40(4):337-44
references.pmid: 15870969
references.citation: Arch Surg. 2007 Oct;142(10):962-8
references.pmid: 17938310
references.citation: Obes Surg. 2005 Sep;15(8):1215-7
references.pmid: 16197800
references.citation: Br J Surg. 2006 Mar;93(3):259-60
references.pmid: 16498604
references.citation: Obes Surg. 1991 Dec;1(4):389-395
references.pmid: 10775940
references.citation: J Pathol. 1992 Dec;168(4):357-63
references.pmid: 1484317
references.citation: Eur J Surg Oncol. 2007 Mar;33(2):133-9
references.pmid: 17071041
references.citation: Obes Surg. 2005 Oct;15(9):1332-5
references.pmid: 16259898
references.citation: Hepatogastroenterology. 2012 Mar-Apr;59(114):409-12
references.pmid: 22353507
references.citation: Obes Surg. 2002 Feb;12(1):39-48
references.pmid: 11868296
references.citation: Obes Surg. 2005 Nov-Dec;15(10):1375-8
references.pmid: 16354514
references.citation: Mod Pathol. 1997 Oct;10(10):1021-7
references.pmid: 9346182
references.citation: Endoscopy. 2005 Jun;37(6):566-9
references.pmid: 15933931
references.citation: Cancer Res. 1992 Dec 15;52(24):6735-40
references.pmid: 1458460
references.citation: Obes Surg. 2007 Sep;17(9):1268-71
references.pmid: 18074505
references.citation: J Gastrointest Surg. 2007 Feb;11(2):133-7
references.pmid: 17390161
references.citation: Dig Dis Sci. 2002 Aug;47(8):1891-6
references.pmid: 12184547