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Joel Faintuch, MD, PhD; Robson K. Ishida, MD; Mioko Jacabi, PhD; Adriana S. Ribeiro, MD, PhD; Rogerio Kuga, MD; Paulo Sakai, MD, PhD; Hermes V. Barbeiro, PhD; Denise F. Barbeiro, PhD; Francisco G. Soriano, MD, PhD; Ivan Cecconello, MD, PhD

Arch Surg. 2007;142(10):962-968.

Hypothesis  Mucosal cytokines may be involved in the process of gastric bacterial contamination that may occur after Roux-en-Y bypass for morbid obesity in both gastric chambers, with inflammation and gastritis mostly in the excluded stomach.

Design  A prospective observational study in a homogeneous population with nonspecific complaints.

Setting  Outpatient clinic of a large, public, academic hospital.

Patients  Subjects (n = 37; 26 [70.3%] female; mean ± SD age, 42.4 ± 9.9 years) seen a mean ± SD of 7.3 ± 1.4 years after Roux-en-Y gastric bypass and nonoperated on morbidly obese control subjects (n = 10; 7 [70%] female; mean ± SD age, 44.0 ± 8.9 years).

Intervention  Enteroscopy was performed to collect samples for cytokine assays and bacteriologic studies.

Main Outcome Measures  Concentrations of tumor necrosis factor and transforming growth factor β in the gastric mucosa of both chambers in patients undergoing Roux-en-Y gastric bypass and correlation with bacterial overgrowth and Helicobacter pylori infection.

Results  High microbial counts (>10⁵ colony-forming units per milliliter) were detected in 22 (59.5%) and 7 (18.9%) of the 37 samples from the functional pouch and excluded reservoir, respectively; and H pylori investigation was positive in 6 of 37 samples (16.2%). The tumor necrosis factor concentration (mean ± SD, 2.1 ± 1.9 pg/g of protein) and the transforming growth factor β concentration (mean ± SD, 24.2 ± 12.8 pg/g of protein) in the excluded stomach, but not in the proximal pouch, were elevated with regard to the corpus or antrum of controls, and correlation with bacterial overgrowth and with H pylori infection was demonstrated.

Conclusion  Overexpression of tumor necrosis factor and transforming growth factor β occurred in the distal stomach, positive cytokine correlation with microbial invasion by H pylori and nonspecific germs was seen, and further studies addressing phenotypic and genotypic changes of gastric mucosa are recommended.

Author Affiliations: Department of Gastroenterology (Drs Faintuch and Cecconello) and Endoscopy Service (Drs Ishida, Ribeiro, Kuga, and Sakai), Hospital das Clinicas; Food Microbiology Section, Instituto Adolfo Lutz (Dr Jacabi); and Research Laboratory LIM 51, São Paulo University Medical School (Drs H. V. Barbeiro, D. F. Barbeiro, and Soriano), São Paulo, Brazil.

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