Potential premalignant status of gastric portion excluded after Roux en-Y gastric bypass in obese women: A pilot study

Author(s):Show less -

Ravacci, Graziela Rosa ^[1] ; Ishida, Robson ^[2] ; Torrinhas, Raquel Suzana ^[1] ; Sala, Priscila ^[1] ; Machado, Natasha Mendonca ^[1] ; Fonseca, Danielle Cristina ^[1] ; Baptista Canuto, Gisele Andre ^{[3, 4]} ; Pinto, Ernani ^[5] ; Nascimento, Viviane ^[6] ; Maggi Tavares, Marina Franco ^[3] ; Sakai, Paulo ^[2] ; Faintuch, Joel ^[2] ; Santo, Marco Aurelio ^[2] ; Hourneaux Moura, Eduardo Guimaraes ^[2] ; Artigiani Neto, Ricardo ^[7] ; Logullo, Angela Flavia ^[7] ; Waitzberg, Dan Linetzky ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med FMUSP, Dept Gastroenterol, Lab Metanutri LIM35, Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Inst Quim, Dept Quim Fundamental, Sao Paulo, SP - Brazil

^[4] Univ Fed Bahia, Inst Quim, Dept Quim Analit, Salvador, BA - Brazil

^[5] Univ Sao Paulo, Fac Ciencias Farmaceut, Sao Paulo, SP - Brazil

^[6] ThermoFisher Sci, Sao Paulo, SP - Brazil

^[7] Univ Fed Sao Paulo, Dept Patol, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: SCIENTIFIC REPORTS; v. 9, APR 3 2019.
• Web of Science Citations: 0

Abstract

We evaluated whether the excluded stomach (ES) after Roux-en-Y gastric bypass (RYGB) can represent a premalignant environment. Twenty obese women were prospectively submitted to double-balloon enteroscopy (DBE) with gastric juice and biopsy collection, before and 3 months after RYGB. We then evaluated morphological and molecular changes by combining endoscopic and histopathological analyses with an integrated untargeted metabolomics and transcriptomics multiplatform. Preoperatively, 16 women already presented with gastric histopathological alterations and an increased pH (>= 4.0). These gastric abnormalities worsened after RYGB. A 90-fold increase in the concentration of bile acids was found in ES fluid, which also contained other metabolites commonly found in the intestinal environment, urine, and faeces. In addition, 135 genes were differentially expressed in ES tissue. Combined analysis of metabolic and gene expression data suggested that RYGB promoted activation of biological processes involved in local inflammation, bacteria overgrowth, and cell proliferation sustained by genes involved in carcinogenesis. Accumulated fluid in the ES appears to behave as a potential premalignant environment due to worsening inflammation and changing gene expression patterns that are favorable to the development of cancer. Considering that ES may remain for the rest of the patient's life, long-term ES monitoring is therefore recommended for patients undergoing RYGB. (AU)

• FAPESP's process: 11/09612-3 - Changes in gene expression in gastric and intestinal tissue of type 2 Diabetes patients submitted to Roux-en-Y gastric bypass
• Grantee: Dan Linetzky Waitzberg
• Support Opportunities: Research Projects - Thematic Grants