Increased Gastric Cytokine Production After Roux-en-Y Gastric Bypass for Morbid Obesity

Abstract

Hypothesis: 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.Design: A prospective observational study in a homogeneous population with nonspecific complaints.Setting: Outpatient clinic of a large, public, academic hospital.Patients: 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).Intervention: Enteroscopy was performed to collect samples for cytokine assays and bacteriologic studies.Main Outcome Measures: Concentrations of tumor necrosis factor ␣ and transforming growth factor ␤ in the gastric mucosa of both chambers in patients undergo-ing Roux-en-Y gastric bypass and correlation with bacterial overgrowth and Helicobacter pylori infection.Results: High microbial counts (Ͼ10 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 ␣ concentration (mean±SD, 2.1±1.9 pg/g of protein) and the transforming growth factor ␤ 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. Conclusion:Overexpression of tumor necrosis factor ␣ and transforming growth factor ␤ 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.

Anemia During Pregnancy after Silastic Ring Roux-en-Y Gastric Bypass: Influence of Time to Conception

“…The gastric reservoir had a length of 8-10 cm and a volume of 30-50 mL. A silastic ring (6.3 cm in diameter) was inserted around the pouch 3 cm proximal to the end-toside gastrojejunal anastomosis in order to prevent future dilatation [13].…”

Survival in hostile territory: the microbiota of the stomach

“…Acidity in the bypassed chamber was only reduced to pH 3.3 ± 2.2, which was associated with significantly lower (albeit still elevated) bacterial numbers (Ishida et al ., ). Differences in microbiota composition between the two chambers were not detected, presumably due to the limited number of isolates (Faintuch et al ., ).…”

“…One of these alterations is Roux‐en‐Y gastric bypass surgery, a surgical procedure to treat morbid obesity, which effectively splits the stomach into a small proximal pouch and a larger bypassed chamber. Investigating the same group of patients 4.5–11 years after this operation, these two stomach chambers were analyzed for microbial counts in relation to pH conditions and mucosal cytokine levels, respectively (Faintuch et al ., ; Ishida et al ., ). Elevated numbers of culturable bacteria and fungi were detected in both chambers.…”

Pregnancy Nutritional Indices and Birth Weight After Roux-en-Y Gastric Bypass

“…A silastic ring (6.3 cm in circumference) was inserted around the pouch 3 cm proximal to the end-to-side gastrojejunal anastomosis [13].…”