Microbial Flora of the Stomach after Gastric Bypass for Morbid Obesity

Ishida, Robson Kiyoshi; Faintuch, Joel; Paula, Ana; Risttori, Christiane A.; Silva, Sabrina N.; Gomes, Elaine S.; Mattar, Rejane; Kuga, Rogério; Ribeiro, Adriana S.; Sakai, Paulo; Barbeiro, Hermes Vieira; Barbeiro, Denise Frediani; Soriano, Francisco Garcia; Cecconello, Ivan

doi:10.1007/s11695-007-9139-6

Cited by 59 publications

(47 citation statements)

References 21 publications

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“…15,29,30 Taken together, these results are consistent with cytokine-mediated chronic gastric inflammation after RYGB. For some time, researchers have witnessed gastritis of variable extension and severity in patients undergoing RYGB who were endoscopically examined in the late postoperative period, in particular in the excluded stomach, 10,11 which is coherent with the current observations.…”

Section: Commentsupporting

confidence: 87%

“…17,31 Biliary reflux also has been incriminated in augmented gastric cytokine generation. 17 The excluded stomach after RYGB is prone to biliary reflux, as perceived in clinical experience, 10,11 whereas the functional chamber contains exclusively high corpus and some fundus-type mucosa, which could explain the differences in cytokine release.…”

Section: Commentmentioning

confidence: 99%

“…Evidence of bacterial and fungal colonization of the proximal gastric pouch and the excluded stomach has been registered, along with occasional positive test results for H pylori infection, 10 in the late postoperative period. In these patients, a study of local production of 2 cytokines was undertaken, aiming to correlate such findings with microbial test results and with the clinical and biochemical profile of that population.…”

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confidence: 99%

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

Faintuch¹,

Ishida²,

Jacabi³

et al. 2007

Arch Surg

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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.

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Section: Commentsupporting

confidence: 87%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

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

Faintuch¹,

Ishida²,

Jacabi³

et al. 2007

Arch Surg

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“…A gastroenterostomy to a Roux-en-Y limb of the jejunum completes the operation. It has been hypothesized that this reduction of gastric volume has a major impact on the physiological function of the stomach, and may lead to gastric hypoacidity because of impaired gastric gland secretion [12] . This presumption is supported by the fact that the intake of proton pump inhibitors can frequently be decreased after bariatric surgery [13] .…”

Section: Discussionmentioning

confidence: 99%

Bariatric Surgery: A Novel Risk Factor for Food Allergy?

Blockhuys

Faber²,

Sabato³

et al. 2017

Int Arch Allergy Immunol

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“…The uncharged substances can pass through the mucosal lining of the gastrointestinal tract [19]. The standard bariatric surgery bypass reduces the hydrochloric acid secretion in the stomach and can act on the charge of the drugs depending of their specific acid dissociation constant (pKa) [34]. The pKa of a drug is a key physicochemical parameter influencing many biopharmaceutical characteristics.…”

Section: Factors Affecting the Bioavailability Of Drugsmentioning

confidence: 99%

Oral Contraceptives after Bariatric Surgery

Schlatter

2017

Obes Facts

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Objective: Bariatric surgery offers a highly effective mode of treatment for obese patients. Some procedures such as bypass cause an alteration in normal gastrointestinal tract with possible consequences for the uptake of orally administered drugs. Methods: We assessed the literature to ascertain whether the use of oral drugs and especially oral contraceptives is effective and adequate after bariatric surgery. Results: The bioavailability of drugs could be affected by the solubility and pH of the modified medium after bariatric surgery and by the loss of gastrointestinal transporters. Bariatric surgery could potentially result in a transient change in the absorption of drugs such as analgesics, antibiotics, antiarrhythmics, anticoagulants, psychotropic, and oral contraceptive drugs. Effective contraception is especially critical in the postoperative period, and implants might be representing a safe contraceptive method in women undergoing bariatric surgery. Conclusion: Each drug will have to be evaluated with respect to its site of absorption and its mechanism of absorption, with special attention on parameters influencing the effectiveness of the absorption processes.

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Microbial Flora of the Stomach after Gastric Bypass for Morbid Obesity

Cited by 59 publications

References 21 publications

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

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

Bariatric Surgery: A Novel Risk Factor for Food Allergy?

Oral Contraceptives after Bariatric Surgery

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