Gastric and Jejunal Histopathological Changes in Patients Undergoing Bariatric Surgery

Abstract

Background:Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. Methods:This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results:In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. Conclusion:There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.

Novel Insight into the Mechanism of Metabolic Surgery Causing the Diversity in Glycemic Status in Type 2 Diabetes

“…One study in humans showed that chronic low-grade inflammation of the gastric area and the jejuna significantly reduces at least 1 year after RYGB in patients with or without T2D, in concert with reduction of T2D rate from 41.7 % in preoperation to 11.4 % in postoperation cases [80]. Another intestinal biopsy study shows that RYGB down-regulates the expression of jejunal toll-like receptor 4 (TLR4), which mediates pro-inflammatory mediators in patients with complete and partial T2D remission 3 months after surgery, and the expression of TLR7 in the jejunum is significantly different between complete remission and partial T2D remission [81].…”