Westerink Floris, Huibregtse Inge, De Hoog Marieke, Bruin Sjoerd, Meesters Eelco, Brandjes Desiderius, Gerdes Victor
Department of internal medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
Department of gastroenterology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Inflamm Intest Dis. 2021 May;6(2):109-116. doi: 10.1159/000514576. Epub 2021 Apr 14.
Bariatric surgery induces various gastrointestinal (GI) modifications. We performed the first study longitudinally assessing the effect of bariatric surgery on faecal inflammatory biomarker levels and its relation with GI complaints.
Faecal calprotectin, lactoferrin, and calgranulin-C levels were determined in 41 patients (34 Roux-en-Y [RYGB], 7 sleeves) before and at 6-16 weeks, 6 months, and 1 year after surgery. Changes in biomarker levels and percentage of patients above reference value were determined. Gastrointestinal symptom rating scale (GSRS) was used to assess GI complaints at corresponding time points. The postoperative relation between GSRS score and biomarker levels above reference value was investigated.
After RYGB, median calprotectin levels are significantly higher (>188, 104-415 μg/g) than before surgery (40, 19-78 μg/g; < 0.001), and over 90% of patients have levels above reference value 1 year after surgery. Median lactoferrin was 0.4 (0.2-1.6) μg/g before, and >5.9 (1.8-13.6) μg/g after surgery ( < 0.001). Median calgranulin-C levels remained far below the reference value and were 0.13 (0.05-0.24) μg/g before and <0.23 (0.06-0.33) μg/g after surgery. Similar results were found after sleeve gastrectomy. No difference was seen in GSRS score for patients with calprotectin and lactoferrin levels above reference values.
Faecal inflammatory biomarkers calprotectin and lactoferrin, but not calgranulin-C, rise above reference values shortly after bariatric surgery and remain elevated in the majority of patients. The discrepancy between calprotectin and calgranulin-C levels suggests no GI inflammation. Furthermore, patients after RYGB with biomarkers above the population reference value do not seem to have more GI complaints.
减肥手术会引起各种胃肠道改变。我们开展了首项纵向研究，评估减肥手术对粪便炎症生物标志物水平的影响及其与胃肠道不适的关系。
对41例患者（34例行Roux-en-Y胃旁路术[RYGB]，7例行袖状胃切除术）在手术前、术后6 - 16周、6个月和1年时测定粪便钙卫蛋白、乳铁蛋白和钙粒蛋白C水平。确定生物标志物水平的变化以及高于参考值的患者百分比。在相应时间点使用胃肠道症状评分量表（GSRS）评估胃肠道不适情况。研究术后GSRS评分与高于参考值的生物标志物水平之间的关系。
RYGB术后，钙卫蛋白水平中位数（>188, 104 - 415μg/g）显著高于术前（40, 19 - 78μg/g；<0.001），术后1年超过90%的患者水平高于参考值。乳铁蛋白术前中位数为0.4（0.2 - 1.6）μg/g，术后>5.9（1.8 - 13.6）μg/g（<0.001）。钙粒蛋白C水平中位数仍远低于参考值，术前为0.13（0.05 - 0.24）μg/g，术后<0.23（0.06 - 0.33）μg/g。袖状胃切除术后也发现了类似结果。钙卫蛋白和乳铁蛋白水平高于参考值的患者，其GSRS评分无差异。
减肥手术后不久，粪便炎症生物标志物钙卫蛋白和乳铁蛋白，但不包括钙粒蛋白C，会升高至参考值以上，且大多数患者仍保持升高状态。钙卫蛋白和钙粒蛋白C水平的差异表明不存在胃肠道炎症。此外，RYGB术后生物标志物高于人群参考值的患者似乎没有更多的胃肠道不适。
