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Ammendola M, Vescio F, Rotondo C, Arturi F, Luposella M, Zuccalà V, Battaglia C, Laganà D, Ranieri G, Navarra G, Curcio S, Danese V, Franzoso L, De Luca GM, Prete FP, Testini M, Currò G. Macrophages and Mast Cells in the Gastric Mucosa of Patients with Obesity Undergoing Sleeve Gastrectomy. J Clin Med 2024; 13:4434. [PMID: 39124701 PMCID: PMC11312978 DOI: 10.3390/jcm13154434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background. Adipose tissue macrophages (ATMs) and mast cells (MCs) play a role in immune responses. More recently, their involvement in tumor angiogenesis and chronic inflammatory conditions in patients with obesity has been discovered. Furthermore, a higher BMI (Body Mass Index) value corresponds to a higher inflammatory state. In particular, gastric tissue in obesity (GTO) is characterized by Macrophages, Mast Cells Positive to Triptase (MCPT), and neo-formed microvessels (MVD). Materials and Methods. We collected gastric tissue samples from December 2021 to December 2022. The patients selected had a BMI > 35 kg/m2 with different comorbidities. Regarding the surgery, surgeons executed a Laparoscopic Sleeve Gastrectomy (LapSG). Gastric tissue was analyzed by immunohistochemistry and morphometrical assay, comparing "obese-related" gastric tissue to normal gastric tissue. Furthermore, tissue parameters were correlated with important clinicopathological features. Results. We collected thirty gastric tissue samples from thirty patients with obesity. Blood tests, Electrocardiogram (ECG), esophagogastroduodenoscopy (EGDS) associated with a urea breath test, and chest X.R. were performed. A significant correlation between ATMs, MCPT, MVD, and BMI was found in GTO. Pearson t-test analysis was conducted (r ranged from 0.67 to 0.71; p-value < 0.05). Conclusions. These preliminary data suggest that ATMs, MCPT, and MVD related to BMI can play a role in both gastric tissue angiogenesis and inflammation inducing a tissue change that could lead to gastric inflammation or cancer diseases.
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Affiliation(s)
- Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University “Magna Graecia” Medical School, University Hospital “R. Dulbecco”, 88100 Catanzaro, Italy; (M.A.); (F.V.); (C.R.); (S.C.)
| | - Francesca Vescio
- Science of Health Department, Digestive Surgery Unit, University “Magna Graecia” Medical School, University Hospital “R. Dulbecco”, 88100 Catanzaro, Italy; (M.A.); (F.V.); (C.R.); (S.C.)
| | - Cataldo Rotondo
- Science of Health Department, Digestive Surgery Unit, University “Magna Graecia” Medical School, University Hospital “R. Dulbecco”, 88100 Catanzaro, Italy; (M.A.); (F.V.); (C.R.); (S.C.)
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University “Magna Graecia” Medical School, Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital “R. Dulbecco”, 88100 Catanzaro, Italy;
| | - Maria Luposella
- Cardiovascular Disease Unit, General Hospital, 88100 Catanzaro, Italy;
| | - Valeria Zuccalà
- Pathology Unit, “R. Dulbecco” University Hospital, 88100 Catanzaro, Italy;
| | - Caterina Battaglia
- Department of Experimental and Clinical Medicine, “Magna Graecia” University Medical School, Radiology Unit, “R. Dulbecco” University Hospital, 88100 Catanzaro, Italy; (C.B.); (D.L.)
| | - Domenico Laganà
- Department of Experimental and Clinical Medicine, “Magna Graecia” University Medical School, Radiology Unit, “R. Dulbecco” University Hospital, 88100 Catanzaro, Italy; (C.B.); (D.L.)
| | - Girolamo Ranieri
- Oncology Unit, IRCCS National Cancer Istitute “Giovanni Paolo II”, 70100 Bari, Italy;
| | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, “G. Martino” Hospital, University of Messina, 98121 Messina, Italy;
| | - Silvia Curcio
- Science of Health Department, Digestive Surgery Unit, University “Magna Graecia” Medical School, University Hospital “R. Dulbecco”, 88100 Catanzaro, Italy; (M.A.); (F.V.); (C.R.); (S.C.)
| | - Viviana Danese
- Department of Chemistry and Technologies Pharmaceuticals, University of Bari “Aldo Moro”, 70100 Bari, Italy;
| | - Lucia Franzoso
- Department of Anesthesia and Intensive Care, “SS. Annunziata Hospital”, 74121 Taranto, Italy;
| | - Giuseppe Massimiliano De Luca
- Academic Unit of General Surgery “V. Bonomo”, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “A. Moro”, 70100 Bari, Italy; (F.P.P.); (M.T.)
| | - Francesco Paolo Prete
- Academic Unit of General Surgery “V. Bonomo”, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “A. Moro”, 70100 Bari, Italy; (F.P.P.); (M.T.)
| | - Mario Testini
- Academic Unit of General Surgery “V. Bonomo”, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “A. Moro”, 70100 Bari, Italy; (F.P.P.); (M.T.)
| | - Giuseppe Currò
- Science of Health Department, University “Magna Graecia” Medical School, “R.Dulbecco” University Hospital, General Surgery Unit, 88100 Catanzaro, Italy;
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Baillargeon D, Greenblatt M, Côté M, Nadeau M, Couture CY, Hould FS, Bouvet-Bouchard L, Tchernof A, Biertho L. Prevalence of Helicobacter pylori Infection in Bariatric Surgery Patients. Obes Surg 2023; 33:2132-2138. [PMID: 37202576 DOI: 10.1007/s11695-023-06638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To determine the rate of histology-proven Helicobacter pylori (HP) infection in patients undergoing bariatric surgery and to identify risk factors for HP infection. METHODS In a retrospective analysis, patients who underwent bariatric surgery with gastric resection in a single hospital between January 2004 and January 2019 were analyzed. For each patient, a surgical specimen was submitted for anatomopathological examination and analyzed for gastritis or other anomalies. When gastritis was present, HP infection was confirmed by the identification of curvilinear bacilli in conventional histology or by specific immunohistochemical detection of HP antigen. RESULTS A total of 6388 specimens were available for review (4365 women, 2023 men) with a mean age of 44.9 ± 11.2 years and a mean body mass index (BMI) of 49.3 ± 8.2 kg/m2. Histology-proven HP infection rate was 6.3% (n = 405). There was no significant difference in sex, BMI, and body weight between HP + and HP - patients. Logistic regressions identified age as a risk factor for HP infection in this population (OR 1.02, p < 0.0001, CI 95% 1.01-1.03 for every 1-year increase, OR 1.26, p < 0.0001, CI 95% 1.14-1.40 for every 10-year increase). CONCLUSIONS The rate of histology-proven HP infection is low in patients with severe obesity who present for bariatric surgery and is associated with age.
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Affiliation(s)
- David Baillargeon
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
| | - Matthew Greenblatt
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
| | - Marianne Côté
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
- École de Nutrition, Faculté Des Sciences de L'agriculture Et de L'alimentation, Université Laval, Québec, Québec, Canada
| | - Mélanie Nadeau
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
| | - Christian-Yves Couture
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
- Département de Biologie Moléculaire, Université Laval, Biochimie Médicale Et Pathologie, Québec, Québec, Canada
| | - Frédéric-Simon Hould
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
- Département de Chirurgie, Université Laval, Faculté de Médecine, Québec, Québec, Canada
| | - Léonie Bouvet-Bouchard
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
- Département de Chirurgie, Université Laval, Faculté de Médecine, Québec, Québec, Canada
| | - André Tchernof
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada
- École de Nutrition, Faculté Des Sciences de L'agriculture Et de L'alimentation, Université Laval, Québec, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V 4G5, Canada.
- Département de Chirurgie, Université Laval, Faculté de Médecine, Québec, Québec, Canada.
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3
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Zhang T, Zhang B, Xu J, Ren S, Huang S, Shi Z, Guo S, Bian L, Wang P, Wang F, Cai Y, Tang X. Chinese herbal compound prescriptions combined with Chinese medicine powder based on traditional Chinese medicine syndrome differentiation for treatment of chronic atrophic gastritis with erosion: a multi-center, randomized, positive-controlled clinical trial. Chin Med 2022; 17:142. [PMID: 36550503 PMCID: PMC9773465 DOI: 10.1186/s13020-022-00692-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this study, Chinese herbal compound prescriptions combined with Chinese medicine powder were evaluated for the treatment of chronic atrophic gastritis with erosion. METHODS This multi-center, randomized, positive drug control clinical trial randomly assigned 216 patients with chronic atrophic gastritis with erosion to three groups: (1) control group: aluminum plus magnesium suspension thrice per day for 4 weeks; (2) test group 1: Chinese herbal compound prescriptions twice a day plus Sanqi (Panax notoginseng) powder twice a day for 4 weeks; (3) test group 2: Chinese herbal compound prescriptions twice a day plus Sanqi (Panax notoginseng) powder and Zhebeimu (Fritillaria thunbergii Miq.) powder twice a day for 4 weeks. The primary endpoint (improvement of gastric mucosal erosion; improvement of gastric mucosal pathology) and secondary endpoints (improvement of clinical symptoms scores; improvement of the patient-reported outcome [PRO] instrument for chronic gastrointestinal diseases) were assessed using endoscopy at week 4 following the treatment. Drug-related adverse events (AEs) and adverse drug reactions (ADRs) were also compared. RESULTS The final analysis included 202 patients (control group, 63; test group 1, 69; test group 2, 70). At week 4, using within-group comparison, gastric mucosal erosion improved in each group following treatment with a significant difference (P < 0.05); there were no statistically significant differences in gastric mucosal erosion scores among the groups after treatment (P > 0.05); in terms of improvement of gastric mucosal erosion, the efficacy rate of the control group was 69.12%, the efficacy rate of the test group 1 was 73.24%, and the efficacy rate of the test group 2 was 69.01% and efficacy rate among the groups was not statistically significant (P > 0.05). As determined by acute inflammation, chronic inflammation, atrophy, intestinal metaplasia, and dysplasia, the pathological score (total score and the highest score) did not differ statistically among groups following treatment (P > 0.05); within the control group, the total scores of acute inflammation, chronic inflammation, atrophy, and intestinal metaplasia were significantly decreased (P < 0.05), but there was no significant improvement in dysplasia (P > 0.05); in the test group 1, chronic inflammation, atrophy, and intestinal metaplasia and dysplasia scores were significantly decreased (P < 0.05), but acute inflammation did not improve (P > 0.05); there was a significant reduction in the atrophy score in test group 2 (P < 0.05), but no improvement in the scores of acute inflammation, chronic inflammation, intestinal metaplasia, and dysplasia was observed (P > 0.05). Similarly, within the control group, the highest scores of acute inflammation, chronic inflammation, atrophy, and intestinal metaplasia were significantly decreased (P < 0.05), but there was no significant improvement in dysplasia (P > 0.05); there was a significant reduction in highest scores of atrophy, intestinal metaplasia, and dysplasia (P < 0.05) in test group 1, but the highest scores didn't not improve with acute inflammation and chronic inflammation (P > 0.05); there was a significant reduction in the highest atrophy score in test group 2 (P < 0.05), but no improvement in the highest scores of acute inflammation, chronic inflammation, intestinal metaplasia, and dysplasia was observed (P > 0.05). Compared to the control group, the main symptom scores and total symptom scores in the test groups were lower following treatment, with a statistically significant difference (P < 0.05); the analysis of covariance with center, erosion type, and group as factors was applied, and the comparison among the groups in dyspepsia, defecation, and total PRO instrument scores were statistically significant (P < 0.05). In the study period, AEs were reported in 3 (4.23%) patients in the test group 1 and 3 (4.41%) patients in the control group; ADRs were confirmed in 3 (4.23%) patients from the test group 1 and 2 (2.94%) from the control group. AEs and ADRs were not statistically significantly different among groups (AE, P = 0.2213; ADR, P = 0.2872). No serious AE or ADR was reported. CONCLUSIONS This study has shown that both aluminum plus magnesium suspension and Chinese herbal compound prescriptions together with Panax notoginseng powder are capable of improving gastric mucosal erosion and reducing gastric mucosal pathological scores, and there were no statistically significant differences among the groups in primary endpoints, indicating that Chinese herbal therapy can achieve similar efficacy than antacids in terms of primary outcomes. The aluminum plus magnesium suspension is comparable to Chinese herbal therapy in improving atrophy and intestinal metaplasia, and is inferior to Chinese herbal therapy in improving dysplasia. In addition, the Chinese herbal therapy significantly outperforms the aluminum plus magnesium suspension in improving symptoms. Therefore, the overall clinical outcome of Chinese herbal compound prescriptions together with Panax notoginseng powder based on TCM syndrome patterns in the treatment of erosive gastritis is superior to that of antacids. Trial registration ChiCTR, ChiCTR-IPR-15005905. Registered 22 January 2015, https://www.chictr.org.cn/showproj.aspx?proj=10359.
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Affiliation(s)
- Tai Zhang
- grid.464481.b0000 0004 4687 044XXiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XDepartment of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Beihua Zhang
- grid.464481.b0000 0004 4687 044XXiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XDepartment of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinkang Xu
- grid.470041.60000 0004 8513 0268Department of Gastroenterology, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China
| | - Shunping Ren
- grid.163032.50000 0004 1760 2008Department of Gastroenterology, The Hospital of Shanxi University of Chinese Medicine, Taiyuan, China
| | - Shaogang Huang
- grid.411866.c0000 0000 8848 7685Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhaohong Shi
- grid.410609.aDepartment of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, China
| | - Shaoju Guo
- grid.411866.c0000 0000 8848 7685Department of Gastroenterology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Liqun Bian
- grid.464481.b0000 0004 4687 044XXiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XDepartment of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ping Wang
- grid.464481.b0000 0004 4687 044XXiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XDepartment of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengyun Wang
- grid.464481.b0000 0004 4687 044XXiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XDepartment of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yidong Cai
- grid.464481.b0000 0004 4687 044XXiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XDepartment of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China ,grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xudong Tang
- grid.464481.b0000 0004 4687 044XInstitute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Clapp B, Kara AM, Nguyen-Lee PJ, Alvarado L, Marr JD, Annabi HM, Davis B, Ghanem OM. Does the use of bioabsorbable mesh for hiatal hernia repair at the time of bariatric surgery reduce recurrence rates? A meta-analysis. Surg Obes Relat Dis 2022; 18:1407-1415. [PMID: 36104252 DOI: 10.1016/j.soard.2022.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/15/2022] [Accepted: 08/03/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anywhere from 16% to 37% of patients undergoing bariatric and metabolic surgery are estimated to have a hiatal hernia. To address the lack of long-term data showing the efficacy of bioabsorbable mesh in reducing the recurrence of hiatal hernia in patients who undergo bariatric surgery, we evaluated the world literature and performed a meta-analysis. OBJECTIVE To evaluate hiatal hernia recurrence rates after placement of bioabsorbable mesh in bariatric patients. SETTING Meta-analysis of world literature. METHODS We performed a literature search using PubMed and MEDLINE with search terms including "hiatal hernia recurrence," "bariatric surgery," "bioabsorbable mesh," "Gore BIO-A," and "trimethylene carbonate." Analysis was conducted to compare surgical time, length of stay, recurrence rate, hernia size, and changes in body mass index before and after surgery between mesh-group (MG) and nonmesh (NM) patients. The meta-analysis was described using standardized mean difference, weighted mean difference, effect size, and 95% confidence interval (CI). An I2 statistic was computed to assess heterogeneity. RESULTS Twelve studies with 1351 patients were included in our meta-analysis. Four studies had both an MG and an NM group. There were 668 patients in the MG and 683 patients in the NM group. Hernia size noted in the NM group (7 cm2) was compared with that in the MG (6.5 cm2) (95% CI: 3.89-9.14; P = .86). The MG had fewer recurrences than the NM group (effect size, 2% versus 14%; 95% CI: -.26 to -.02; P = .027). The average follow-up was 28.8 months for the MG and 32.8 months for the NM group. CONCLUSION Repair with bioabsorbable mesh at the time of the index bariatric surgery is more effective at reducing the recurrence rate of hiatal hernia than suture cruroplasty. Further studies investigating the long-term outcomes of bioabsorbable mesh placed at the time of bariatric surgery are needed.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas.
| | - Ali M Kara
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas
| | - Paul J Nguyen-Lee
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas
| | - Luis Alvarado
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas
| | - John D Marr
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas
| | - Hani M Annabi
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas
| | - Brian Davis
- Department of Surgery, Texas Tech Health Sciences Center School of Medicine, El Paso Texas
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Kinoshita Y, Arita S, Ogawa T, Takenouchi A, Inagaki-Ohara K. Augmented leptin-induced trefoil factor 3 expression and epidermal growth factor receptor transactivation differentially influences neoplasia progression in the stomach and colorectum of dietary fat-induced obese mice. Arch Biochem Biophys 2022; 729:109379. [PMID: 36002083 DOI: 10.1016/j.abb.2022.109379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/02/2022]
Abstract
Obesity is a risk factor for gastrointestinal malignancies and tumors. However, which factors either protect or predispose the gastrointestinal organs to high-fat diet (HFD)-induced neoplasia remains unclear. Here, we demonstrate that HFD impacts the stomach to a greater extent as compared to the colorectum, resulting in leptin receptor (LepR) signaling-mediated neoplasia in the tissues. HFD activated leptin signaling, which in turn, accelerates the pathogenesis in the gastric mucosa more than that in the colorectum along with ectopic TFF3 expression. Moreover, in the stomach, higher levels of phosphorylated epidermal growth factor receptor (EGFR) in addition to the activation of STAT3 and Akt were observed as compared to the colorectum. The mice with LepR deletion in the gastrointestinal epithelium exhibited a suppressed induction of leptin, TFF3, and phosphorylated EGFR in the stomach, whereas the levels in the colorectum were insignificant. In co-transfected COS-7 cells with LepR and EGFR plasmid DNA, leptin transactivated EGFR to accelerate TFF3 induction along with activation of STAT3, ERK1/2, Akt, and PI3K p85/p55. Furthermore, TFF3 could bind to EGFR but did not transactivate LepR. Leptin-induced TFF3 induction was markedly suppressed by inhibitors of PI3K (LY294002) and EGFR (Erlotinib). Together, these results suggest a novel role of LepR-mediated signaling in transactivating EGFR that leads to TFF3 expression via the PI3K-Akt pathway. Therefore, this study sheds light on the identification of potentially new therapeutic targets for the treatment of pre-cancerous symptoms in stomach and colorectum.
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Affiliation(s)
- Yuta Kinoshita
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima, 727-0023, Japan
| | - Seiya Arita
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima, 727-0023, Japan
| | - Takumi Ogawa
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima, 727-0023, Japan
| | - Ayane Takenouchi
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima, 727-0023, Japan
| | - Kyoko Inagaki-Ohara
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima, 727-0023, Japan.
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Liu H, Qin Y, Yang J, Huang G, Wei X, Wang L, Li W. Helicobacter pylori Infection as a Risk Factor for Abnormal Serum Protein Levels in General Population of China. J Inflamm Res 2022; 15:2009-2017. [PMID: 35370414 PMCID: PMC8968220 DOI: 10.2147/jir.s355446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- He Liu
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
| | - Yan Qin
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
| | - Jie Yang
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
| | - Guoxiu Huang
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
| | - Xiaoying Wei
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
| | - Lulu Wang
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
| | - Wei Li
- Department of Health Management, The People’s Hospital of Guangxi Zhuang Autonomous Region & Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, People’s Republic of China
- Correspondence: Wei Li; Lulu Wang, Email ;
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Lin E, Yeoh AJ, Popov V. Obesity-Related Gastrointestinal Disorders. NUTRITION, WEIGHT, AND DIGESTIVE HEALTH 2022:207-219. [DOI: 10.1007/978-3-030-94953-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Rohof WO, Smout AJ. Hiatus Hernia and Gastroesophageal Reflux Disease. THE ESOPHAGUS 2021:347-357. [DOI: 10.1002/9781119599692.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg 2021; 30:3135-3153. [PMID: 32472360 DOI: 10.1007/s11695-020-04720-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
One of the roles of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) is to provide guidance on the management of patients seeking surgery for adiposity-based chronic diseases. The role of endoscopy around the time of endoscopy is an area of clinical controversy. In 2018, IFSO commissioned a task force to determine the role of endoscopy before and after surgery for the management of adiposity and adiposity-based chronic diseases. The following position statement is issued by the IFSO Endoscopy in Bariatric/Metabolic Surgery Taskforce. It has been approved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Endoscopy in the Morbidly Obese: A Case Highlighting Healthcare Inequities. Am J Gastroenterol 2021; 116:229-233. [PMID: 33337658 DOI: 10.14309/ajg.0000000000001081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
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Qi XY, Gong Y, Jiao YW, Zhao J, Zhou Y, Cui XH, Li S, Yang HJ, Qian J, Tang LM. Influence of Helicobacter pylori Infection on Outcomes After Bariatric Surgery: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiao-yang Qi
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yu Gong
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yu-wen Jiao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jie Zhao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yan Zhou
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiao-han Cui
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Song Li
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hao-jun Yang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jun Qian
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-ming Tang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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Pavelko Y, Bustos R, Gruessner S, Hassan C. Acute Hiatal Hernia with Incarcerated Proximal Half of Recent Sleeve Gastrectomy: Super Rare Complication. Obes Surg 2020; 31:469-471. [PMID: 33179217 DOI: 10.1007/s11695-020-05101-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Vertical sleeve gastrectomy (VSG) has become the most commonly performed operation for the treatment of morbid obesity (JAMA. 312(9):959-61, 2014). Nevertheless, VSG is still associated with some early postoperative complications (JAMA. 312(9):959-61, 2014; Surg Obes Relat Dis. 9(5):816-29, 2013; Obes Surg. 27(8):1944-1951, 2017). Hiatal hernia is a complication that has been widely described in the literature, but not in the immediate postoperative course (Obes Surg. 17(7):962-9, 2007). We, herein, report a case of an acute postoperative hiatal hernia after sleeve gastrectomy. METHODS A 29-year-old female (BMI 38.54 kg/m2) presented to our center and her options for metabolic surgery were discussed. Laparoscopic sleeve gastrectomy (LSG) was the chosen procedure. Preoperative assessment includes a chest x-ray, and standard lab-work up was within a normal limit. Barium swallow did not show any evidence of hiatal hernia. She underwent a LSG. On POD 1, she was able to pass the bariatric clears trial and was discharged home. Three days after discharge, the patient was complaining of constant nausea and vomiting, and chest pain, and was diagnosed with acute hiatal hernia with the incarceration of the proximal sleeve. The patient was taken to the operating room. RESULTS Postoperatively, the patient started on the usual bariatric clinical pathway which she tolerated well and was discharged on the POD 4. The operative time was 156 min. The estimated blood loss was 50 ml. CONCLUSIONS Our report highlights the need for more broad differential diagnosis in early post sleeve gastrectomy patients. Those who are presented with nausea and vomiting in the early postoperative period should be evaluated for possible post sleeve hiatal hernia with a potential risk of strangulation.
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Affiliation(s)
- Yevhen Pavelko
- UI Health-Division of General, Minimally Invasive & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 South Wood Street, Rm 609, Clinical Sciences North Chicago, Chicago, IL, 60612, USA.
| | - Roberto Bustos
- UI Health-Division of General, Minimally Invasive & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 South Wood Street, Rm 609, Clinical Sciences North Chicago, Chicago, IL, 60612, USA
| | - Stephan Gruessner
- UI Health-Division of General, Minimally Invasive & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 South Wood Street, Rm 609, Clinical Sciences North Chicago, Chicago, IL, 60612, USA
| | - Chandra Hassan
- UI Health-Division of General, Minimally Invasive & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 South Wood Street, Rm 609, Clinical Sciences North Chicago, Chicago, IL, 60612, USA
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Tsuji N, Umehara Y, Takenaka M, Minami Y, Watanabe T, Nishida N, Kudo M. Verrucous antral gastritis in relation to Helicobacter pylori infection, nutrition, and gastric atrophy. Gastroenterol Rep (Oxf) 2020; 8:293-298. [PMID: 32843976 PMCID: PMC7434579 DOI: 10.1093/gastro/goz057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/28/2019] [Accepted: 09/29/2019] [Indexed: 11/14/2022] Open
Abstract
Background There have been few studies in the English literature regarding verrucous gastritis (VG). The present study investigated the clinical and endoscopic features of verrucous antral gastritis, especially focusing on Helicobacter pylori infection, nutrition, and gastric atrophy. Methods We performed a retrospective study of patients who underwent routine endoscopy with indigo carmine chromoendoscopy and a comparative study was conducted between VG-positive and VG-negative groups. VG was subdivided into classical and numerous types based on the number and distribution of verrucous lesions. Demographic, clinical, and endoscopic data including body mass index (BMI), serum albumin and cholesterol, gastric atrophy, reflux oesophagitis, Barrett's oesophagus, and H. pylori status were collected. Univariate and multivariable analyses were performed to identify factors associated with VG. Results We analysed the data of 621 patients undergoing routine endoscopy and found that VG (n = 352) was significantly associated with increased BMI (1.12 [1.05-1.18], P < 0.01), reflux esophagitis (1.96 [1.10-3.28], P < 0.01), and H. pylori negativity with or without a history of eradication (9.94 [6.00-16.47] and 6.12 [3.51-10.68], P < 0.001, respectively). Numerous-type (n = 163) VG was associated with both closed- and open-type gastric atrophy (9.9 [4.04-21.37] and 8.10 [3.41-19.24], P < 0.001, respectively). There were no statistical differences between groups regarding age, sex, total cholesterol, albumin, and bile-colored gastric juice. Conclusions Verrucous antral gastritis was related to increased BMI, reflux esophagitis, and H. pylori negativity. Numerous-type verrucous lesions were associated with gastric atrophy. These indicate that VG may be a physiological phenomenon due to high gastric acidity, mechanical overload, and vulnerability of background mucosa.
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Affiliation(s)
- Naoko Tsuji
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasuko Umehara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Zhu QK, Ren HY, Li XD, Zhai B. Surgical strategy for gastroesophageal reflux disease in patients with obesity. Shijie Huaren Xiaohua Zazhi 2020; 28:43-49. [DOI: 10.11569/wcjd.v28.i2.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) and obesity have become serious problems affecting global health. The surgical treatment strategy for GERD patients with obesity is still a difficult point. In particular, obesity exacerbates the occurrence of GERD, and simple anti-reflux surgery has limited efficacy in obese patients. Currently, bariatric surgery is a good choice for the treatment of such patients, and Roux-en-Y gastric bypass is the best choice. Revisional surgery remains to be standardized for serious complications in postoperative patients. In addition, the new anti-reflux bariatric surgery that has been emerging in recent years is expected to be an effective alternative treatment for GERD patients with obesity.
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Affiliation(s)
- Qian-Kun Zhu
- Department of Hepatobiliary Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Hai-Yang Ren
- Department of Hepatobiliary Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xiao-Dong Li
- Department of Hepatobiliary Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Bo Zhai
- Department of Hepatobiliary Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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Bakhos CT, Patel SP, Petrov RV, Abbas AES. Management of Paraesophageal Hernia in the Morbidly Obese Patient. Thorac Surg Clin 2019; 29:379-386. [DOI: 10.1016/j.thorsurg.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bou Daher H, Sharara AI. Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: The burning questions. World J Gastroenterol 2019; 25:4805-4813. [PMID: 31543675 PMCID: PMC6737315 DOI: 10.3748/wjg.v25.i33.4805] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/03/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity is a global health epidemic with considerable economic burden. Surgical solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced risk. Sleeve gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease (GERD) has been a topic of debate. GERD, including erosive esophagitis, is highly prevalent in the obese population. The role of pre-operative endoscopy in bariatric surgery has been controversial. Two schools of thought exist on the matter, one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal pathology. This debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy (LSG) with de novo and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass procedure. In this paper, we try to address 3 burning questions regarding the inter-relationship of obesity, GERD, and LSG: (1) What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery? (2) Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery? And (3) What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?
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Affiliation(s)
- Halim Bou Daher
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Arita S, Ogawa T, Murakami Y, Kinoshita Y, Okazaki M, Inagaki-Ohara K. Dietary Fat-Accelerating Leptin Signaling Promotes Protumorigenic Gastric Environment in Mice. Nutrients 2019; 11:nu11092127. [PMID: 31489936 PMCID: PMC6770546 DOI: 10.3390/nu11092127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022] Open
Abstract
Excess of fat intake leads to obesity and causes a variety of metabolic diseases and cancer. We previously demonstrated that high-lard diet induces intestinal metaplasia, a precancerous lesion of the stomach mediated by leptin signaling. This study aims to investigate which kinds of dietary fat cause the intestinal metaplasia onset. We fed eight kinds of high-fat diets (HFDs) of animal or plant origin to mice evaluated their effect on gastric pathogenesis. Five types of dietary fat were divided according to their observed effects: Obese with high metaplasia (group I; beef tallow, lard, and hydrogenated coconut oil), non-obese with high metaplasia (group II; linseed oil), obese without metaplasia (group III; corn oil and olive oil), non-obese without metaplasia (group IV, soybean oil) and lean without metaplasia (group V; cocoa butter). The group I and II diets induced leptin, phosphorylated leptin receptor (ObR), signal transducer and activator 3 (STAT3), and increased intracellular β-catenin accumulation in the stomach. Moreover, mice fed these HFDs with 1-methyl-3-nitro-1-nitrosoguanidine (MNNG), a gastric carcinogen, and further accelerated dysplasia in the stomach. Lactobacillus occupancy in the stomach increased in all HFDs except hydrogenated coconut oil. Our findings suggest that HFDs inducing leptin signaling accelerate the enhancement of protumorigenic gastric microenvironment independent of body mass gain or microbiome changes.
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Affiliation(s)
- Seiya Arita
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima 727-0023, Japan
| | - Takumi Ogawa
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima 727-0023, Japan
| | - Yuta Murakami
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima 727-0023, Japan
| | - Yuta Kinoshita
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima 727-0023, Japan
| | - Masaharu Okazaki
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima 727-0023, Japan
| | - Kyoko Inagaki-Ohara
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 5562 Nanatsuka, Shobara, Hiroshima 727-0023, Japan.
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High-fat-diet-induced modulations of leptin signaling and gastric microbiota drive precancerous lesions in the stomach. Nutrition 2019; 67-68:110556. [PMID: 31554603 DOI: 10.1016/j.nut.2019.110556] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Obesity is a risk factor for malignancy in various tissues, and has been associated with gut microbiota alterations. However, the link between obesity-associated microbiota and gastric pathogenesis has not been clarified. We demonstrated that high-fat-diet (HFD) feeding causes intestinal metaplasia, which are precancerous lesions of the stomach, with augmented gastric leptin signaling. The aim of this study was to investigate the precise role of leptin signaling in the altered microbiota composition and pathogenesis in the stomach during diet-induced obesity. METHODS Male C57 BL/6 J, leptin receptor (Lepr)-mutated db/db, and gastrointestinal epithelium-specific Lepr conditional knockout (T3 b-Lepr cKO) mice were fed a HFD or control diet. Gastrointestinal microbiota was analyzed by 16 S rRNA gene sequences and quantitative polymerase chain reaction. Transplantation of gastric microbiota of HFD-fed mice was performed to evaluate metaplasia onset in recipient mice. RESULTS One week of HFD caused severe microbial dysbiosis in the stomach. The microbiota changes were accompanied by increased gastric leptin, leading to the consequent development of intestinal metaplasia. Transplantation of gastric microbiota from HFD-fed mice induced intestinal metaplasia in recipient mice; however, only a limited effect on pathogenesis was noted. HFD-fed db/db mice did not show a decrease in microbial abundance. Moreover, T3 b-Lepr cKO mice failed spontaneous obesity, and suppressed decreased abundance of gastric microbiota and occurrence of intestinal metaplasia during HFD feeding similar to db/db mice. CONCLUSIONS Gastric leptin signaling modulates the gastric microbiota community and regulates the pathogenesis in the gastric mucosa.
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Al Sulaiti MA, Darwish A, Al Khalifa K. Intussusception after laparoscopic one anastomosis gastric bypass: A rare complication. Int J Surg Case Rep 2019; 60:270-272. [PMID: 31261045 PMCID: PMC6610225 DOI: 10.1016/j.ijscr.2019.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Intussusception after one anastomosis gastric bypass is a rare postoperative complication that occurs with bowel obstruction. The diagnosis may be challenging because of long-standing, intermittent, nonspecific symptoms. Our paper describes an unusual case of antegrade intussusception that occurred 28 months after laparoscopic one anastomosis gastric bypass surgery. PRESENTATION A 30-year-old female known to have diabetes mellitus type 2, who presented with epigastric pain. A computed tomography scan revealed a jejuno-jejunal intussusception. After resection and primary end-to-end hand-sewn anastomosis of the biliary limb, the patient was discharged on the 6th day postoperatively and recovered uneventfully. We belief this is the first report describing a case of intussusception post one anastomosis gastric bypass. DISCUSSION Gastric bypass surgeries have recently become a popular method for the surgical treatment of morbid obesity worldwide. The reported intussusception incidence after Roux-en-Y gastric bypass (RYGB) is approximately 0.1-0.3%, but not described in one anastomosis gastric bypass surgery. Approximately two-thirds of patients show recurrent chronic and colicky pain. Surgical intervention is essential. CONCLUSION Clinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.
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Affiliation(s)
| | - Abdulla Darwish
- Pathology Department, Bahrain Defense Force Hospital, Bahrain.
| | - Khalid Al Khalifa
- Department of General Surgery, Bahrain Defence Force Hospital, Bahrain.
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Is it Necessary to Send the Sleeve Gastrectomy Specimens to Pathology? Surg Laparosc Endosc Percutan Tech 2019; 29:117-119. [DOI: 10.1097/sle.0000000000000607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aimasso U, D'onofrio V, D'eusebio C, Devecchi A, Pira C, Merlo FD, De Francesco A. Helicobacter pylori and nutrition: a bidirectional communication. MINERVA GASTROENTERO 2019; 65:116-129. [PMID: 30759976 DOI: 10.23736/s1121-421x.19.02568-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Helicobacter pylori (HP) is a gram-negative flagellated pathogen acid-resistant bacterium; it belongs to the order Campylobacterales that is wide spread all over the world, infecting more than 50% of the world population. HP infection is etiologically associated with non-atrophic and atrophic gastritis, peptic ulcer and with 3 to 6-fold increased relative risk for developing gastric adenocarcinoma and mucosa-associated lymphoid tissue (MA LT) lymphoma. For this reason HP is recognized by the World Health Organization as a Class I human carcinogen. In the last years a lot of studies clarified the role of this pathogen in nutrition and metabolism; particularly, it has been shown that it is able to induce malabsorption of several nutrients like iron, cobalamin, vitamin C and vitamin E, with strong consequences on nutritional status. Interesting, this bacterium is able to produce different biological effects on hormones like ghrelin and leptin controlling both appetite and growth, mostly depending on the time of acquisition of the infection and of its treatment. In this review, the authors focused their attention on nutritional effects of HP infection and particularly on the role that diet, food, plants and specific nutrients can play in its treatment, considering that HP eradication rates, with standard triple-therapy, have fallen to a low level in the last years.
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Affiliation(s)
- Umberto Aimasso
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy -
| | - Valentina D'onofrio
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy
| | - Chiara D'eusebio
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Devecchi
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy
| | - Costanza Pira
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy
| | - Fabio D Merlo
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy
| | - Antonella De Francesco
- Unit of Dietetics and Clinical Nutrition, Città della Salute e della Scienza, Turin, Italy
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Role of Adiponectin in Endoscopic Gastritis. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.3.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hamrah MS, Hamrah MH, Ishii H, Suzuki S, Hamrah MH, Hamrah AE, Dahi AE, Takeshita K, Hamrah MH, Fotouhi A, Sakamoto J, Murohara T. Association between Helicobacter pylori Infection and Cardiovascular Risk Factors among Patients in the Northern Part of Afghanistan: a Cross-Sectional Study in Andkhoy City. Asian Pac J Cancer Prev 2018; 19:1035-1039. [PMID: 29693980 PMCID: PMC6031800 DOI: 10.22034/apjcp.2018.19.4.1035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background: The association between Helicobacter pylori infection and cardiovascular risk factors remains controversial. The high prevalence of H. pylori infection among Afghan patients warranted the investigation of this association. The aim of the present study was to determine the association between H. pylori infection and cardiovascular risk factors among patients visiting an outpatient clinic in Andkhoy, Afghanistan. Methods: We performed a cross-sectional study of 271 consecutive patients in an outpatient clinic in Andkhoy, Afghanistan from April 2017 to June 2017. The diagnosis of H. pylori infection was achieved using an enzyme-linked immunosorbent assay test. The patients were divided into H. pylori positive (n=189) and H. pylori negative (n=82) groups. The association between H. pylori infection and cardiovascular risk factors was analyzed. Results: Of the total 271 study participants, 102 (37.6%) were male and 169 (62.4%) female. The mean age ± standard deviation of the patients who were H. pylori-positive and H. pylori-negative was 51.0 ± 17.6 years and 51.6 ± 17.6 years, respectively. In multivariate logistic regression analyses, H. pylori infection was significantly associated with diabetes mellitus (DM) (odds ratio [OR] 3.16, 95% confidence interval [CI] 1.31-7.62, P = 0.011), and body mass index (BMI) levels (OR 1.17, 95% CI 108-1.26, P < 0.001). Conclusions: Our study indicated that H. pylori infection was significantly associated with DM and elevated BMI levels in patients from an outpatient clinic in Andkhoy, Afghanistan. More aggressive measures, including DM, obesity control, and H. pylori eradication are needed.
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Xu MY, Liu L, Yuan BS, Yin J, Lu QB. Association of obesity with Helicobacter pylori infection: A retrospective study. World J Gastroenterol 2017; 23:2750-2756. [PMID: 28487612 PMCID: PMC5403754 DOI: 10.3748/wjg.v23.i15.2750] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/17/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the association between Helicobacter pylori (H. pylori) infection and obesity/weight gain in a Chinese population.
METHODS Our primary outcome was the change in body mass index (BMI). The generalized linear models were used to explore the association between H. pylori infection and the change of BMI, and the logistic regression models were used to explore the association between H. pylori infection and obesity.
RESULTS A total of 3039 subjects were recruited and analyzed, of which 12.8% were obese. The prevalence of H. pylori infection was 53.9% (1639/3039) overall and 54.6% (212/388) in the obese subjects. The change of BMI in the H. pylori (+) group was not significantly higher than that in the H. pylori (-) group after adjustment for potential confounding factors [RR = 0.988, 95%CI: 0.924-1.057, P = 0.729]. The prevalence of obesity decreased 1.1% in the H. pylori (+) group and 0.5% in the H. pylori (-) group. The RR of H. pylori infection for obesity was 0.831 (95%CI: 0.577-1.197, P = 0.321) after the adjustment.
CONCLUSION H. pylori infection was not associated with overweight/obesity observed from the retrospective study in this Chinese population.
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Zatorski H. Pathophysiology and Risk Factors in Peptic Ulcer Disease. INTRODUCTION TO GASTROINTESTINAL DISEASES VOL. 2 2017:7-20. [DOI: 10.1007/978-3-319-59885-7_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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Influence of metabolic syndrome on upper gastrointestinal disease. Clin J Gastroenterol 2016; 9:191-202. [PMID: 27372302 DOI: 10.1007/s12328-016-0668-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/19/2016] [Indexed: 12/22/2022]
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Bouchoucha M, Fysekidis M, Julia C, Airinei G, Catheline JM, Reach G, Benamouzig R. Functional Gastrointestinal Disorders in Obese Patients. The Importance of the Enrollment Source. Obes Surg 2016; 25:2143-52. [PMID: 25904236 DOI: 10.1007/s11695-015-1679-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity is frequently associated to many functional gastrointestinal disorders. The aim of the present study was to assess the prevalence of functional gastrointestinal disorders in obese patients, according to their body mass index and their recruitment source. METHODS Five hundred ninety-six obese patients (body mass index (BMI) > 30) filled out a standard questionnaire in order to evaluate the presence of functional gastrointestinal disorders. They were divided into four groups according to the Rome III criteria and their BMI: OF, obese patients from functional gastrointestinal disorder (FGID) enrollment; OO, obese patients from obesity management enrollment; MF, morbid obesity patients from FGID enrollment; and MO, morbid obesity patients from obesity management enrollment. Data analysis was performed using multivariate logistic regression. RESULTS Out of the 596 obese patients included in the present study, 183 (33 %) were complaining of FGIDs, while 413 (67 %) were consulting for obesity management. Compared to the OF group, the OO patients had a higher prevalence of females (P = 0.008) and a younger age (P < 0.001). Clinically, they reported a lower incidence of regurgitation (P = 0.044), of chest pain (P = 0.004), of irritable bowel syndrome (IBS; P = 0.035), and of functional diarrhea (P = 0.030). Compared to the MF group, the MO patients had an older age (P = 0.001), a higher BMI (P = 0.013), and clinically by a high frequency of functional dyspepsia (P = 0.006). There were symptoms that had similar prevalence in all groups (OF, OO, MF, MO) such as epigastric pain, postprandial distress, constipation, diarrhea, bloating, abdominal pain soiling, or nonspecific anorectal disorders. CONCLUSIONS This study has shown that the recruitment source accounted for marked and specific differences in the prevalence of functional gastrointestinal disorders in obesity and morbid obesity. Symptoms with similar prevalence in all groups should be systematically detected in all patients.
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Affiliation(s)
- Michel Bouchoucha
- Physiology Department, Université René Descartes, Paris V, Paris, France. .,Gastroenterology Department, Avicenne Hospital, Bobigny, France.
| | - Marinos Fysekidis
- Diabetes, Nutrition and Endocrinology Department, Avicenne Hospital, Bobigny, France
| | - Chantal Julia
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), UFR SMBH 74 rue Marcel Cachin, 93017, Bobigny, France
| | | | | | - Gérard Reach
- Diabetes, Nutrition and Endocrinology Department, Avicenne Hospital, Bobigny, France
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Inagaki-Ohara K, Okamoto S, Takagi K, Saito K, Arita S, Tang L, Hori T, Kataoka H, Matsumoto S, Minokoshi Y. Leptin receptor signaling is required for high-fat diet-induced atrophic gastritis in mice. Nutr Metab (Lond) 2016; 13:7. [PMID: 26839577 PMCID: PMC4736478 DOI: 10.1186/s12986-016-0066-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/26/2016] [Indexed: 12/25/2022] Open
Abstract
Background Obesity increases the risk for malignancies in various tissues including the stomach. Atrophic gastritis with precancerous lesions is an obesity-associated disease; however, the mechanisms that underlie the development of obesity-associated atrophic gastritis are unknown. Leptin is a hormone derived from stomach as well as adipose tissue and gastric leptin is involved in the development of gastric cancer. The aim of the current study is to investigate the involvement of leptin receptor signaling in the development of atrophic gastritis during diet-induced obesity. Methods Male C57BL/6, ob/ob and db/db mice were fed a high-fat diet (HFD) or a control diet (CD) from 1 week to 5 months. Pathological changes of the gastric mucosa and the expression of molecules associated with atrophic gastritis were evaluated in these mice. Results HFD feeding induced gastric mucosal hyperplasia with increased gastric leptin expression. Mucosal hyperplasia was accompanied by a higher frequency of Ki67-positive proliferating cells and atrophy of the gastric glands in the presence of inflammation, which increased following HFD feeding. Activation of ObR signaling-associated molecules such as ObR, STAT3, Akt, and ERK was detected in the gastric mucosa of mice fed the HFD for 1 week. The morphological alterations associated with gastric mucosal atrophy and the expression of Muc2 and Cdx2 resemble those associated with human intestinal metaplasia. In contrast to wild-type mice, leptin-deficient ob/ob mice and leptin receptor-mutated db/db mice did not show increased Cdx2 expression in response to HFD feeding. Conclusion Together, these results suggest that activation of the leptin signaling pathway in the stomach is required to develop obesity-associated atrophic gastritis. Electronic supplementary material The online version of this article (doi:10.1186/s12986-016-0066-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyoko Inagaki-Ohara
- Research Institute, National Center for Global Health and Medicine (NCGM), 1-21-1, Toyama Shinjuku, Tokyo, 162-0052 Japan ; Division of Endocrinology and Metabolism, Department of Developmental Physiology, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585 Japan ; Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 562 Nanatsuka, Shobara, Hiroshima 727-0023 Japan
| | - Shiki Okamoto
- Division of Endocrinology and Metabolism, Department of Developmental Physiology, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585 Japan
| | - Kazuyo Takagi
- Division of Endocrinology and Metabolism, Department of Developmental Physiology, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585 Japan
| | - Kumiko Saito
- Division of Endocrinology and Metabolism, Department of Developmental Physiology, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585 Japan
| | - Seiya Arita
- Division of Host Defense, Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, 562 Nanatsuka, Shobara, Hiroshima 727-0023 Japan
| | - Lijun Tang
- Division of Endocrinology and Metabolism, Department of Developmental Physiology, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585 Japan
| | - Tetsuji Hori
- Yakult Central Institute for Microbiological Research, 5-11 Izumi, Kunitachi, Tokyo, 186-8650 Japan
| | - Hiroaki Kataoka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692 Japan
| | - Satoshi Matsumoto
- Yakult Central Institute for Microbiological Research, 5-11 Izumi, Kunitachi, Tokyo, 186-8650 Japan
| | - Yasuhiko Minokoshi
- Division of Endocrinology and Metabolism, Department of Developmental Physiology, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585 Japan
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Sokolovskaya E, Shinde T. Comparison of utilization rate of CT scans of the abdomen and pelvis in patients with elevated BMI compared to patients with normal BMI presenting to the ER with gastrointestinal symptoms. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jericó C, Bretón I, García Ruiz de Gordejuela A, de Oliveira AC, Rubio MÁ, Tinahones FJ, Vidal J, Vilarrasa N. [Diagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery]. ACTA ACUST UNITED AC 2015; 63:32-42. [PMID: 26611153 DOI: 10.1016/j.endonu.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.
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Affiliation(s)
- Carlos Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Barcelona, España. Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org).
| | - Irene Bretón
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Gregorio Marañón, Madrid, España
| | - Amador García Ruiz de Gordejuela
- Unidad de Cirugía Bariátrica y Metabólica. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Francisco J Tinahones
- Servicio de Endocrinología, Hospital Virgen de la Victoria, Málaga, España; CIBEROBN Instituto de Salud Carlos III, Madrid, España
| | - Josep Vidal
- Unidad de obesidad, Hospital Clínic Universitari, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, España
| | - Nuria Vilarrasa
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Bellvitge-IDIBELL, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
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Eslick GD, Howell SC, Talley NJ. Dysmotility Symptoms Are Independently Associated With Weight Change: A Population-based Study of Australian Adults. J Neurogastroenterol Motil 2015; 21:603-11. [PMID: 26424045 PMCID: PMC4622143 DOI: 10.5056/jnm14124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 04/16/2015] [Accepted: 07/16/2015] [Indexed: 01/12/2023] Open
Abstract
Background/Aims Weight loss is a recognized alarm symptom for organic gastrointestinal (GI) disease, yet the association between weight change (loss or gain) and specific GI symptoms remains poorly described. We assess the associations between GI symptoms and weight change in a population-based sample of Australian adults. Methods The prevalence of 26 GI symptoms was determined by a postal survey to 5000 residents in western Sydney, Australia (60% response rate). These were classified a priori into 5 symptom groups–abdominal pain, esophageal symptoms, dysmotility symptoms, diarrhea and constipation. Weight change was measured by two items which assessed weight loss and weight gain. Clinically relevant weight change was defined as a loss or gain of 3 or more kilograms in the past 3 months. Results Prevalence estimates for clinically relevant weight loss and gain in the past 3 months were 10.3% and 8.1%, respectively. When the 5 symptom groups were evaluated simultaneously, the dysmotility symptoms of fullness after meals emerged as a predictor of both weight loss (OR, 1.57; 95% CI, 1.32–1.88; P < 0.001) and weight gain (OR, 0.85; 95% CI, 0.72–0.99; P = 0.040), which also included bloating (OR, 1.64; 95% CI 1.46–1.84; P < 0.001). The associations remained significant following adjustment for socio-economic status, body mass index, and eating behaviors. Conclusions Specific dysmotility symptoms are independently predictive of both weight loss and weight gain. Different pathogenic mechanisms may be involved.
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Affiliation(s)
- Guy D Eslick
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Stuart C Howell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Nicholas J Talley
- Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.,Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
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Johnson LK, Holven KB, Nordstrand N, Mellembakken JR, Tanbo T, Hjelmesæth J. Fructose content of low calorie diets: effect on cardiometabolic risk factors in obese women with polycystic ovarian syndrome: a randomized controlled trial. Endocr Connect 2015; 4:144-54. [PMID: 26138702 PMCID: PMC4488759 DOI: 10.1530/ec-15-0047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We aimed to examine whether a whole-grain crispbread (CB) low-fructose, low-calorie diet (LCD) might be superior to a traditional LCD based on fructose-rich liquid meal replacements (LMRs) with respect to improvement of various cardiometabolic risk factors and reproductive hormones. Parallel-group randomised controlled clinical trial. Morbidly obese women with polycystic ovarian syndrome (PCOS) were randomised to either an 8-week CB-LCD or LMR-LCD (900-1100 kcal/day, fructose 17 g/day or 85 g/day). A total of 51 women completed the study. Body weight, fat mass and waist circumference reduced by mean (s.d.) 10.0 (4.8) kg, 7.4 (4.2) kg and 8.5 (4.4) cm, with no significant differences between groups. Total-cholesterol, HDL-cholesterol and Apo-A1 were significantly reduced within both groups (all P values <0.01), with no significant between-group differences. The triacylglycerol and LDL-cholesterol levels were reduced within the LMR group only, with no significant between-group differences. Blood pressure and most measures of glucose metabolism improved significantly in both diet groups, with no significant between-group difference. Uric acid levels rose by 17.7 (46.4) and 30.6 (71.5) μmol/l in the CB and LMR group, respectively, with no significant difference between groups. Gastrointestinal discomfort was significantly and equally reduced in both intervention groups. Free testosterone index was reduced in both groups, with no significant difference between groups. Morbidly obese women with PCOS who underwent either an 8-week low or high-fructose LCD-diet had similar changes in various cardiometabolic risk factors and reproductive hormones. Registration at ClinicalTrials.gov: NCT00779571.
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Affiliation(s)
- Line K Johnson
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Kirsten B Holven
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Njord Nordstrand
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Jan R Mellembakken
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Tom Tanbo
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
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Boules M, Corcelles R, Guerron AD, Dong M, Daigle CR, El-Hayek K, Schauer PR, Brethauer SA, Rodriguez J, Kroh M. The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery. Surgery 2015; 158:911-6; discussion 916-8. [PMID: 26243345 DOI: 10.1016/j.surg.2015.06.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/15/2015] [Accepted: 06/27/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the incidence and outcomes of hiatal hernias (HH) that are repaired concomitantly during bariatric surgery. METHODS We identified patients who had concomitant HH repair during bariatric surgery from 2010 to 2014. Data collected included baseline demographics, perioperative parameters, type of HH repair, and postoperative outcomes. RESULTS A total of 83 underwent concomitant HH during study period. The male-to-female ratio was 1:8, mean age was 57.2 ± 10.0 years, and mean body mass index was 44.5 ± 7.9 kg/m(2). A total of 61 patients had laparoscopic Roux-en-Y gastric bypass, and 22 had laparoscopic sleeve gastrectomy. HH was diagnosed before bariatric surgery in 32 (39%) subjects, whereas 51 (61%) were diagnosed intraoperatively. Primary hernia repair was performed with anterior reconstruction in 45 (54%) patients, posterior in 21 (25%), and additional mesh placement in 7 (8%). A total of 24 early minor postoperative symptoms were reported. At 12 month follow-up, mean body mass index improved to 30.0 ± 6.2 kg/m(2), and anti-reflux medication was decreased from 84% preoperatively to 52%. Late postoperative complications were observed in 3 patients. A comparative analysis with a matched 1:1 control group displayed no significant differences in operative time (P = .07), duration of stay (P = .9), intraoperative complications, or early (P = .09) and late post-operative symptoms (P = .3). In addition, no differences were noted in terms of weight-loss outcomes. CONCLUSION The true incidence of HH may be underestimated before bariatric surgery. Combined repair of HH during bariatric surgery appears safe and feasible.
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Affiliation(s)
- Mena Boules
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH; Fundació Clínic per la Recerca Biomèdica, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Matthew Dong
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | | | - Kevin El-Hayek
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH; Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | | | - John Rodriguez
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
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Lauti M, Gormack SE, Thomas JM, Morrow JJ, Rahman H, MacCormick AD. What Does the Excised Stomach from Sleeve Gastrectomy Tell us? Obes Surg 2015. [DOI: 10.1007/s11695-015-1832-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[Upper endoscopy findings in obese morbid patients candidates for bariatric surgery]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:426-30. [PMID: 25709107 DOI: 10.1016/j.gastrohep.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/03/2015] [Accepted: 01/12/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Body mass index has been associated with the presence and severity of various gastrointestinal symptoms. The aim of the study was to analyze the endoscopic findings and gastric histology of morbidly obese candidates for bariatric surgery. METHODS We retrospectively included patients undergoing bariatric surgery at the Hospital de León from March 2005 to April 2013. The findings of upper gastrointestinal endoscopy and antral histology were collected. The relationship of body mass index (BMI) with gastroscopy findings and the presence of Helicobacter pylori were assessed. RESULTS A total of 194 patients were included. An abnormality on endoscopy or antral biopsy was found in 48.7% and 78.9% of the patients, respectively. Three patients had gastric peptic ulcer, and consequently the intervention was postponed until healing. H.pylori infection was found in 63.9% of the patients. The presence of H.pylori and endoscopic findings were not related to BMI. CONCLUSION Gastroesophageal disease is common in morbidly obese patients and approximately half of the patients had some kind of alteration on endoscopy. Gastroscopy and H.pylori testing prior to surgery is required to rule out disease that could delay or contraindicate surgery.
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Al-Sanea O, Al-Garzaie A, Dernaika M, Haddad J. Rare complication post sleeve gastrectomy: Acute irreducible paraesophageal hernia. Int J Surg Case Rep 2015; 8C:88-91. [PMID: 25644556 PMCID: PMC4353937 DOI: 10.1016/j.ijscr.2015.01.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/17/2015] [Accepted: 01/25/2015] [Indexed: 01/07/2023] Open
Abstract
Since early postoperative nausea and vomiting are fairly common, a high index of suspicion was essential for the diagnosis. Taking into account the asymptomatic intrathoracic sleeve migration described in the literature, thoracic cuts of the CT Scan are essential in post sleeve evaluation. Sleeve gastrectomy might disrupt the lower esophageal sphincter pressure and aggravate a pre-existing asymptomatic weak sphincter. The only other 2 reported cases occurred in the setting of a hiatal hernia. In ours no hiatal defect was observed. Introduction Laparoscopic sleeve gastrectomy has been accepted as a standalone effective bariatric procedure. With the increase in the number of cases done worldwide, we are witnessing the emergence of new unexpected complications. Presentation A seemingly straight forward sleeve gastrectomy was complicated by acute post-operative vomiting which was diagnosed as an acute intra thoracic migration of part of the new sleeve. Surgical repair was done, with reduction and fixation of the stomach. Patient was subsequently relieved of his symptoms and discharged. Discussion This is a rare complication of a relatively well studied operation. Faced with severe post operative repeated vomiting, clinical suspicion and correct use of all para-clinical tools should help delineate the cause. Conclusion We report this case hoping to expand the existing literature on the topic and to highlight the potential role of gastrophrenic membrane dissection in the occurrence of such complication.
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Affiliation(s)
- Osamah Al-Sanea
- Bariatric and Metabolic Surgery Department, Somna Care, Procare Riaya Hospital, Al Khobar, Saudi Arabia
| | - Ahmed Al-Garzaie
- Bariatric and Metabolic Surgery Department, Somna Care, Procare Riaya Hospital, Al Khobar, Saudi Arabia
| | - Mohamad Dernaika
- Gastroenterology Department, Somna Care, Procare Riaya Hospital, Al Khobar, Saudi Arabia
| | - Johnny Haddad
- Bariatric and Metabolic Surgery Department, Somna Care, Procare Riaya Hospital, Al Khobar, Saudi Arabia.
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Huseini M, Wood GC, Seiler J, Argyropoulos G, Irving BA, Gerhard GS, Benotti P, Still C, Rolston DDK. Gastrointestinal symptoms in morbid obesity. Front Med (Lausanne) 2014; 1:49. [PMID: 25593922 PMCID: PMC4292065 DOI: 10.3389/fmed.2014.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/16/2014] [Indexed: 12/27/2022] Open
Abstract
Background: Several reports have shown an increased prevalence of gastrointestinal (GI) symptoms in obese subjects in community-based studies. To better understand the role of the GI tract in obesity, and because there are limited clinic-based studies, we documented the prevalence of upper and lower GI symptoms in morbidly obese individuals in a clinic setting. Objective: The aim of our study was to compare the prevalence of GI symptoms in morbidly obese individuals in a weight management clinic with non-obese individuals with similar comorbidities as morbidly obese individuals in an Internal Medicine clinic. Methods: Class II and III obese patients BMI >35 kg/m2 (N = 114) and 182 non-obese patients (BMI <25 kg/m2) completed the GI symptoms survey between August 2011 and April 2012 were included in this study. The survey included 24 items pertaining to upper and lower GI symptoms. The participants rated the frequency of symptoms as absent (never, rarely) or present (occasionally, frequently). The symptoms were clustered into five categories: oral symptoms, dysphagia, gastroesophageal reflux, abdominal pain, and bowel habits. Responses to each symptom cluster were compared between obese group and normal weight groups using logistic regression. Results: Of the 24 items, 18 had a higher frequency in the obese group (p < 0.005 for each). After adjusting for age and gender, the obese patients were more likely to have upper GI symptoms: any oral symptom (OR = 2.3, p = 0.0013), dysphagia (OR 2.9, p = 0.0006), and any gastroesophageal reflux (OR 3.8, p < 0.0001). Similarly, the obese patients were more likely to have lower GI symptoms: any abdominal pain (OR = 1.7, p = 0.042) and altered bowel habits (OR = 2.8, p < 0.0001). Conclusion: These observations suggest a statistically significant increase in frequency of both upper and lower GI symptoms in morbidly obese patients when compared to non-obese subjects.
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Affiliation(s)
- Mustafa Huseini
- Institute of Obesity, Geisinger Health System , Danville, PA , USA
| | - G Craig Wood
- Institute of Obesity, Geisinger Health System , Danville, PA , USA
| | - Jamie Seiler
- Institute of Obesity, Geisinger Health System , Danville, PA , USA
| | | | - Brian A Irving
- Institute of Obesity, Geisinger Health System , Danville, PA , USA
| | - Glenn S Gerhard
- Institute of Obesity, Geisinger Health System , Danville, PA , USA ; Department of Biochemistry, Molecular Biology, Pathology and Laboratory Medicine, Pennsylvania State University , Hershey, PA , USA
| | - Peter Benotti
- Institute of Obesity, Geisinger Health System , Danville, PA , USA
| | | | - David D K Rolston
- Institute of Obesity, Geisinger Health System , Danville, PA , USA ; Department of Internal Medicine, Geisinger Health System , Danville, PA , USA
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Combining laparoscopic giant paraesophageal hernia repair with sleeve gastrectomy in obese patients. Surg Endosc 2014; 29:1115-22. [DOI: 10.1007/s00464-014-3771-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
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Wong HM, Yang W, Yang J, Wang C. The value of routine gastroscopy before laparoscopic Roux-en-Y gastric bypass surgery in Chinese patients. Surg Obes Relat Dis 2014; 11:303-7. [PMID: 25541111 DOI: 10.1016/j.soard.2014.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 05/08/2014] [Accepted: 06/22/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Obesity is closely related to upper gastrointestinal diseases. China has a high incidence of gastropathy. Postoperative examination of the distal stomach becomes extremely difficult after laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). Whether preoperative routine gastroscopy should be performed at all remains controversial. The objective of this study was to explore the value of routine gastroscopy before performing LRYGB in Chinese patients. METHODS The preoperative gastroscopy reports of 180 patients who had undergone LRYGB for morbid obesity and/or metabolic syndrome in the Department of Gastrointestinal Surgery of our hospital from January 2009 to August 2013 were retrospectively analyzed. RESULTS Gastroscopy showed chronic superficial gastritis (n = 159, 88.3%), reflux esophagitis (n = 19, 10.6%), erosion (n = 69, 38.3%), hiatal hernia (n = 5, 2.8%), gastric ulcer (n = 3, 1.7%), duodenal ulcer (n = 32, 17.8%), and gastric polyps (n = 10, 5.6%). CONCLUSION It is useful to perform gastroscopy before LRYGB. The findings of this investigation can help physicians to develop tailored therapies and procedures and thus improve the prognosis considerably. Gastroscopy should be routinely performed in Chinese patients who are planning to undergo bariatric surgery.
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Affiliation(s)
- Hong-Meng Wong
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangdong Province, China
| | - Wah Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangdong Province, China
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangdong Province, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangdong Province, China.
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Patel AD, Lin E. The intersection of foregut and bariatric surgeries: treating the whole, not the parts. Surg Obes Relat Dis 2014; 10:1067-9. [PMID: 24935176 DOI: 10.1016/j.soard.2014.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 02/16/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Ankit D Patel
- Emory Bariatrics Center & Emory Gastroesophageal Treatment Center, Emory University School of Medicine Atlanta, Georgia
| | - Edward Lin
- Emory Bariatrics Center & Emory Gastroesophageal Treatment Center, Emory University School of Medicine Atlanta, Georgia
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Carabotti M, D’Ercole C, Iossa A, Corazziari E, Silecchia G, Severi C. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol 2014; 20:647-653. [PMID: 24574738 PMCID: PMC3921474 DOI: 10.3748/wjg.v20.i3.647] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/12/2013] [Accepted: 11/30/2013] [Indexed: 02/07/2023] Open
Abstract
The present review summarizes the prevalence and active clinical problems in obese patients with Helicobacter pylori (H. pylori) infection, as well as the outcomes after bariatric surgery in this patient population. The involvement of H. pylori in the pathophysiology of obesity is still debated. It may be that the infection is protective against obesity, because of the gastritis-induced decrease in production and secretion of the orexigenic hormone ghrelin. However, recent epidemiological studies have failed to show an association between H. pylori infection and reduced body mass index. H. pylori infection might represent a limiting factor in the access to bariatric bypass surgery, even if high-quality evidence indicating the advantages of preoperative H. pylori screening and eradication is lacking. The clinical management of infection is complicated by the lower eradication rates with standard therapeutic regimens reported in obese patients than in the normal-weight population. Prospective clinical studies to ameliorate both H. pylori eradication rates and control the clinical outcomes of H. pylori infection after different bariatric procedures are warranted.
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Abstract
Adiponectin is a protein synthesized and secreted predominantly by adipocytes into the peripheral blood. However, circulating adiponectin level is inversely related with body weight, especially visceral fat accumulation. The mechanism of this paradoxical relation remains obscure. Low circulating adiponectin concentrations (hypoadiponectinemia; <4 μg/mL) are associated with a variety of diseases, including dysmetabolism (type 2 diabetes, insulin resistance, hypertension, dyslipidemia, metabolic syndrome, hyperuricemia), atherosclerosis (coronary artery disease, stroke, peripheral artery disease), sleep apnea, non-alcoholic fatty liver disease, gastritis and gastro-esophageal reflux disease, inflammatory bowel diseases, pancreatitis, osteoporosis, and cancer (endometrial cancer, postmenopausal breast cancer, leukemia, colon cancer, gastric cancer, prostate cancer). On the other hand, hyperadiponectinemia is associated with cardiac, renal and pulmonary diseases. This review article focuses on the significance of adiponectin as a clinical biomarker of obesity-related diseases. Routine measurement of adiponectin in patients with lifestyle-related diseases is highly recommended.
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Affiliation(s)
- Ken Kishida
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Tohru Funahashi
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Søvik TT, Karlsson J, Aasheim ET, Fagerland MW, Björkman S, Engström M, Kristinsson J, Olbers T, Mala T. Gastrointestinal function and eating behavior after gastric bypass and duodenal switch. Surg Obes Relat Dis 2013; 9:641-7. [DOI: 10.1016/j.soard.2012.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/04/2012] [Accepted: 06/11/2012] [Indexed: 01/07/2023]
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Pham DV, Protyniak B, Binenbaum SJ, Squillaro A, Borao FJ. Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese. Surg Obes Relat Dis 2013; 10:257-61. [PMID: 24209882 DOI: 10.1016/j.soard.2013.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/18/2013] [Accepted: 08/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Morbid obesity is associated with increased rates of hiatal and paraesophageal hernias. Although laparoscopic sleeve gastrectomy is gaining popularity as the procedure of choice for morbid obesity, there is little data regarding the management of paraesophageal hernias found intraoperatively. The aim of this study was to evaluate the feasibility and benefits of a combined sleeve gastrectomy and paraesophageal hernia repair in morbidly obese patients. METHODS From May 2011 to February 2013, 23 patients underwent laparoscopic sleeve gastrectomy combined with the repair of a paraesophageal hernia. Only 4 patients had a large hiatal hernia documented preoperatively on esophagogastroduodenoscopy (EGD). The body mass index (BMI), operative time, length of stay, and complications were evaluated. RESULTS The average operative time was 165 minutes (115-240 minutes) and length of stay was 2.83 days (2-6 days). All patients were female except for one, with an average age of 53.4 years and a BMI of 41.9 kg/m(2). There were no complications during the procedures. Mean follow-up was 6.16 months (1-19 months), and mean excess weight loss was 39%. The average cost of admission for a combined procedure ($10,056), was slightly higher than a laparoscopic sleeve gastrectomy ($8905) or laparoscopic paraesophageal hernia repair ($8954) done separately. CONCLUSIONS Laparoscopic sleeve gastrectomy combined with a paraesophageal hernia repair is well-tolerated and feasible in morbidly obese patients. Surgeons should be aware that preoperative EGD is not effective at diagnosing large hiatal or paraesophageal hernias. Surgeons with the skill set to repair paraesophageal hernias should do a combined procedure because it is well-tolerated, feasible, and can reduce the cost of multiple hospital admissions.
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Affiliation(s)
- David V Pham
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey.
| | - Bogdan Protyniak
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey
| | | | - Anthony Squillaro
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey
| | - Frank J Borao
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey
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Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis 2013; 9:920-4. [PMID: 23810611 DOI: 10.1016/j.soard.2013.03.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/03/2013] [Accepted: 03/03/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Morbidly obese patients commonly have gastroesophageal reflux (GERD) and associated hiatal hernias. As such, some surgeons routinely perform a concomitant hiatal hernia repair during bariatric surgery. However, the intraoperative inspection for a hiatal hernia based on laparoscopic visualization can be misleading. The aim of this study was to assess the prevalence of hiatal hernias in morbidly obese patients based on preoperative upper gastrointestinal (GI) contrast study. METHODS Data on 181 patients who underwent routine upper GI contrast study as part of a preoperative workup for bariatric surgery were reviewed. The upper GI studies were examined for the presence of hiatal hernias and GERD. Hiatal hernias were categorized by size as small (≤2 cm), moderate (2-5 cm), or large (>5 cm). GERD was based on radiologic evidence and categorized as mild, moderate, or severe. RESULTS The mean age of the cohort was 44 years, with a mean body mass index of 43 kg/m(2). Of the 181 patients overall, based on the upper GI contrast study, the prevalence of hiatal hernia was 37.0% and of GERD was 39.8%; the prevalence of moderate or large hiatal hernia was 4.4%, and the prevalence of moderate or severe GERD was 13.3%. CONCLUSIONS Based on upper GI contrast study, we identified the presence of a hiatal hernia in nearly 40% of morbidly obese patients. The results from this study suggest that surgeons should evaluate the morbidly obese patient for the presence of hiatal hernias and perform concomitant repair at the time of the bariatric procedure, particularly in patients undergoing gastric banding and sleeve gastrectomy, while less so in the gastric bypass patient.
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Affiliation(s)
- Fredrick Che
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
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Zhu L, Mo Z, Yang X, Liu S, Wang G, Li P, Tan J, Ye F, Strain J, Im I, Zhu S. Effect of laparoscopic Roux-en-Y gastroenterostomy with BMI<35 kg/m(2) in type 2 diabetes mellitus. Obes Surg 2013; 22:1562-7. [PMID: 22692669 DOI: 10.1007/s11695-012-0694-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RGB) has been endorsed by the "First World Congress on International Therapies for Type 2 diabetes" as a possible therapeutic option in patients with type 2 diabetes with a body mass index (BMI) of less than 35 kg/m(2). In the present study, we assessed the improvement in clinical indicators associated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with non-obese type 2 diabetes mellitus (T2DM). METHODS LRYGB was performed in 30 T2DM patients with a BMI <35 kg/m(2). The patients were followed up for 1 year. Pre- and postoperative changes in BMI, waist circumference, and biochemical indicators including fasting plasma glucose and glycosylated hemoglobin were recorded. RESULTS Significant reduction in glycosylated hemoglobin from 8.02 ± 1.77 to 5.59 ± 1.02 % (p < 0.05) at 12 months was noted. Diabetes was completely resolved in nine cases, resulting in discontinuation of diabetes-related medication. No significant surgical complications occurred. CONCLUSIONS LRYGB is beneficial for non-obese T2DM patients in China.
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Affiliation(s)
- Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China
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Ye BX, Heng D, Jiang LQ, Wang Y, Zhang HJ, Li XL, Lin L. Association between body mass index, hiatal hernia and gastroesophageal reflux in patients with gastroesophageal reflux disease. Shijie Huaren Xiaohua Zazhi 2012; 20:3375-3379. [DOI: 10.11569/wcjd.v20.i34.3375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the relationship between body mass index (BMI), hiatal hernia (HH) and gastroesophageal reflux (including symptoms and esophagitis) in patients with gastroesophageal reflux disease (GERD).
METHODS: Five hundred and ninety patients diagnosed with GERD at our hospital from June 2008 to Oct 2011 were included in the study. Gastroesophageal reflux symptoms were assessed using the Reflux Disease Questionnaire (RDQ). Erosive esophagitis (EE), non-erosive reflux disease (NERD), and hiatal hernia (HH) were diagnosed by gastroscopy. Patients were categorized into four groups according to BMI: underweight (BMI < 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), and obesity (≥ 25 kg/m2). The clinical characteristics of GERD, relationship between HH and BMI, between BMI/HH and symptoms, and between BMI/HH and EE were analyzed.
RESULTS: RDQ score was 13.33 ± 5.66. EE accounted for 52.2% (308/590). BMI was (23.64±3.10) kg/m2. The percentages of underweight, normal, overweight and obese patients were 3.7% (22/590), 37.0% (218/590), 23.7% (140/590) and 35.6% (210/590), respectively. The incidences of HH were 0, 6.0% (13/218), 12.9% (18/140), and 16.7% (35/210) in underweight, normal, overweight and obese patients, respectively, with a significant difference among these patients (P = 0.001). RDQ scores of underweight, normal, overweight, and obese patients were 11.95 ± 5.86, 13.33 ± 5.50, 13.45 ± 5.22 and 13.40 ± 6.07, respectively (F = 0.465, P = 0.707). RDQ scores were significantly higher in the HH group (17.36 ± 6.66) than in the non-HH group (17.36 ± 6.66 vs 12.83 ± 5.31, P = 0.005, and multivariate analysis showed a significant difference (P = 0.000). The percentage of overweight and obese patients in the EE group was significantly higher than that in the NERD group (P = 0.000). The number of HH patients who suffered from EE was more than that of patients without HH (P = 0.000). Multivariate analysis showed that BMI and HH were important risk factors for EE.
CONCLUSION: HH may be an important mechanism responsible for EE in obese patients. HH has a more important significant association with GERD symptoms than BMI. BMI and HH are risk factors for EE.
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Impact on Perioperative Outcomes of Concomitant Hiatal Hernia Repair with Laparoscopic Gastric Bypass. Obes Surg 2012; 22:1607-10. [DOI: 10.1007/s11695-012-0714-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Weight loss is a recognized alarm symptom for organic gastrointestinal (GI) disease, yet the association between obesity and specific GI symptoms remains poorly described. A meta-analysis was conducted to determine which GI symptoms predominate among obese individuals. A search of the literature using the databases MEDLINE, EMBASE PubMed and Current Contents (1950 - November 2011) was conducted. All studies assessing GI symptoms and increasing body mass index (BMI)/obesity were included. English and non-English articles were searched. A random effect model of the studies was undertaken. Overall, significant associations between GI symptoms and increasing BMI were found for upper abdominal pain (odds ratio [OR] = 2.65, 95% confidence interval [CI]: 1.23-5.72), gastroesophageal reflux (OR = 1.89, 95% CI: 1.70-2.09), diarrhoea (OR = 1.45, 95% CI: 1.26-1.64), chest pain/heartburn (OR = 1.74, 95% CI: 1.49-2.04), vomiting (OR = 1.76, 95% CI: 1.28-2.41), retching (OR = 1.33, 95% CI: 1.01-1.74) and incomplete evacuation (OR = 1.32, 95% CI: 1.03-1.71). However, no significant associations were found for all abdominal pain, lower abdominal pain, bloating, constipation/hard stools, fecal incontinence, nausea and anal blockage. Several key GI symptoms are associated with increasing BMI and obesity. In addition, there were a number of other GI symptoms that had no relationship with obesity. A greater knowledge of the GI symptoms associated with obesity along with the physiology will be important in the clinical management of these patients.
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Affiliation(s)
- G D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
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Yamamoto S, Watabe K, Araki H, Kamada Y, Kato M, Kizu T, Kiso S, Tsutsui S, Tsujii M, Kihara S, Funahashi T, Shimomura I, Hayashi N, Takehara T. Protective role of adiponectin against ethanol-induced gastric injury in mice. Am J Physiol Gastrointest Liver Physiol 2012; 302:G773-80. [PMID: 22323129 DOI: 10.1152/ajpgi.00324.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Adiponectin is an anti-inflammatory molecule released from adipocytes, and serum adiponectin concentrations are reduced in obesity. We previously reported that gastric erosion occurs in association with obesity and low serum adiponectin levels. In the present study, we examined adiponectin-knockout (APN-KO) mice to elucidate the role of adiponectin in gastric mucosal injury. Gastric injury was induced by oral administration of ethanol in wild-type (WT) and APN-KO mice. Ethanol treatment induced severe gastric injury in APN-KO mice compared with WT mice. In APN-KO mice, increased apoptotic cells and decreased expression of prostaglandin E(2) (PGE(2)) were detected in the injured stomach. We next assessed the effect of adiponectin on the cellular response to ethanol treatment and wound repair in rat gastric mucosal cells (RGM1). Adiponectin induced the expression of PGE(2) and cyclooxygenase 2 (COX-2) in ethanol-treated RGM1 cells. RGM1 cells exhibited efficient wound repair accompanied by increased PGE(2) expression in the presence of adiponectin. Coadministration of adiponectin with celecoxib, a COX-2 inhibitor, inhibited efficient wound repair. These findings indicate that adiponectin has a protective role against ethanol-induced gastric mucosal injury in mice. This effect may be partially mediated by the efficient wound repair of epithelial cells via increased PGE(2) expression.
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Affiliation(s)
- Shunsuke Yamamoto
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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