Enzyme activities and morphological appearance in functioning and excluded segments of the small intestine after shunt operation for obesity.

Abstract

SUMMARY Five patients in whom small-intestinal bypass was performed for severe obesity had a second operation 11-19 months later because of insufficient weight loss. Mucosal enzyme activities and histological appearance were investigated in biopsies from different parts of the functioning and excluded small intestine. These were compared with biopsies from corresponding sites obtained at thefirstoperation. In additiontoaprominent increase in length, circumference, and mucosal thickness in the functioning shunt, the disaccharidases and two intracellular ,-galactosidases increased in specific activity, especially in the distal ileal part of the shunt. In the excluded segment of the small intestine different enzymes showed a different response: trehalase increased and alkaline phosphate decreased significantly. Other enzymes that were measured showed a varied pattern. The results indicated that not only the luminal content but also other, presumably hormonal, factors regulated the enzyme activities, and that different regulating factors influenced the various enzymes differently. The marked adaptive increase in mucosal surface of the functioning shunt could be one factor in explaining the weight stabilisation and, in some cases, weight increase after the initial rapid weight loss after the operation for small-intestinal bypass. The increase in specific enzyme activities would further increase the digestive capacity of the shunt.

Mucosal Enzyme Activities, Peptide Hormone Concentrations and Hormone Secretory Granule Properties in Functioning Proximal Jejunum after Shunt Operation for Obesity

“…In the current study lyso somal properties and enzyme activity did not differ from normal. As in this study, previous studies have demonstrated normal levels of cytoplasmic enzymes [2,3,22], Mitochon drial and peroxisomal enzymes have not pre viously been measured but were noted to be normal in this study.…”

“…Asp et al [2,3] demonstrated increase in lysosomal enzyme activity. In the current study lyso somal properties and enzyme activity did not differ from normal.…”

Effect of Antibiotics in the Prevention of Jejunoileal Bypass-Induced Liver Dysfunction

“…Previous in vestigators have demonstrated that increased villus surface area in the experimental blind loop situation actually results in decreased absorption, probably secondary to reduced maturity of the enterocytes [24], In humans, however, post-bypass mucosal hyperplasia is accompanied by increased mucosal disaccharidase levels [25,26]. In addition, we have demonstrated increased absorption after re section of the defunctionalized bowel, a situ ation in which we have previously demon strated increased mucosal protein and DNA content [13,27], In view of the data presented in this study, one cannot conclude that previous studies demonstrating prevention of bypass-induced liver dysfunction by antibiotic administra tion offer firm evidence that bypass-induced liver disease is an endotoxin-mediated pro cess.…”

Intestinal adaptation after jejunoileal bypass for morbid obesity: A possible explanation for inadequate weight loss

“…Jejunoileal bypass in morbid obesity is followed by marked but variable weight loss, the median loss in the Danish Obesity Project (1) being 42.9 kg after 24 months, ranging from 20.5 to 108.5 kg. At reoperation adaptive changes in length of the functioning small intestine (2, 3), crypt depth, villous size (4) and mucosal enzyme activities (5) have been noted, but the correlation between these adaptive changes and the extent of weight loss has not been investigated.…”