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,
Obes Surg. 2013 Oct;23(10):1616-23. doi: 10.1007/s11695-013-0975-2.
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.
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.
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.
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.
Roux-en-Y 胃旁路术治疗病态肥胖后的黏膜改变尚未得到明确评估。本研究旨在分析被排除胃的黏膜改变（增殖状态（Ki-67）；凋亡（半胱天冬酶-3 和 BCL-2）；激素功能（胃泌素））。
对 35 例接受 Roux-en-Y 胃旁路术超过 36 个月的患者进行双气囊小肠镜检查。收集近端袋和被排除的胃黏膜的多处活检。将 32 例未经手术的肥胖患者的胃活检作为对照。内镜活检取自福尔马林固定和石蜡包埋的组织块。使用链霉亲和素-生物素-过氧化物酶法检查 4μm 厚切片的免疫表达。
两组在年龄、性别、胃炎、肠上皮化生和幽门螺杆菌方面具有可比性。对照组胃泌素阳性细胞数平均值为 55.5（标准差（SD）=11.7），病例组为 29.6（SD=7.9），p=0.0003。病例组（体部=24.7%，窦部=24.9%）Ki-67 增殖指数明显高于对照组（体部=15.0%和窦部=17.7%），p=0.002 和 0.01。与对照组相比，病例组中半胱天冬酶-3 的免疫表达更高（46%比 31%），p=0.02。对照组和病例组 CD3、CD8 和 Bcl-2 的免疫表达无统计学差异。
与非手术肥胖对照组相比，被排除的胃黏膜中细胞增殖增加，细胞凋亡减少。在这些情况下，细胞更替和激素分泌的改变可能与长期随访有关。
