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Master's Dissertation
DOI
10.11606/D.5.2007.tde-11122007-160806
Document
Author
Full name
Robson Kiyoshi Ishida
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2007
Supervisor
Committee
Faintuch, Joel (President)
Cleva, Roberto de
Sipahi, Aytan Miranda
Title in Portuguese
Flora bacteriana e citoquínas pró-inflamatórias no trato digestório exclusivo após cirurgia de derivação em Y de Roux para obesidade mórbida
Keywords in Portuguese
Derivação gástrica
Infecções bacterianas e micoses
Inflamação
Interleucinas
Obesidade mórbida
Abstract in Portuguese
Introdução: Em estudo prospectivo, os efeitos da gastroplastia redutora com reconstrução em Y de Roux sobre a flora bacteriana e produção de citoquinas nas câmaras gástricas proximal e excluída foram estudados. Métodos: pacientes bariátricos (n=37) foram submetidos à avaliação endoscópica em ambos reservatórios gástricos,7,3+-1,4 anos após a gastroplastia. Idade foi de 42,4+-9,9 anos (70,2% sexo feminino), IMC pré-operatório de 53,5+-10,6, e IMC atual de 32,6+-7,8kg/m2. TNFalfa e TGF-beta foram medidos pelo método ELISA em biópsias da mucosa gástrica., assim como cultura quantitativa da secreção gástrica, com pH gástrico e teste respiratório lactulose/hidrogênio.Resultados: Nenhum dos pacientes apresentou queixas sugestivas de supercrescimento bacteriano gastrointestinal. Todavia, contagens elevadas de bactérias e fungos foram identificadas nas duas câmaras, principalmente no estômago proximal. Gram-positivos representaram a maioria dos isolados. O pH foi neutro na câmara proximal, enquanto que também na câmara distal nem sempre conservou-se em níveis esperados. Conclusões: 1)Produção elevadas de TNF-alfa e TGF-beta, com a colonização de aeróbios, anaeróbios e fungos em ambas câmaras gástricas foram identificadas; 2)O pH gástrico como a contagem bacteriana foram maiores no estômago proximal funcionante; 3)Teste respiratório foi positivo para supercrescimento bacteriano em 40,5% dos pacientes,entretanto não foram identificadas manifestações clínicas de supercrescimento bacteriano gastrointestinal.
Title in English
Microbial flora and proinflammatory cytokines in excluded digestive tract after Roux en-Y gastric bypass for morbid obesity
Keywords in English
Bacterial flora and cytokines
Bacterial infections and mycoses
Gastric bypass
Inflammatory
Interleukins
Morbid obesity
Abstract in English
Background: In a prospective study, the effect of Roux-en-Y gastric bypass (RYGBP) on bacterial flora and cytokines production in the used (proximal pouch) and unused (large bypassed) gastric chamber was analysed. Methods: Bariatric subjects (n=37) were submitted to endoscopic examination of both gastric reservoirs, 7.3 ± 1.4 years after RYGBP. Age was 42.4 ± 9.9 years (70.2% females), preoperative BMI was 53.5 ± 10.6, and current BMI was 32.6 ± 7.8 kg/m2.TNF-alpha and TGF-beta were meausured by enzyme-linked immunosorbent assay (ELISA) from gastric mucosal biopsies. Quantitative culture of gastric secretion along with gastric pH and actulose/hydrogen breath test were also investigated.Results: None of the subjects displayed complaints suggestive of GI bacterial overgrowth. Elevated counts of bacteria and fungi were identified in both chambers, mostly in the proximal stomach. Gram-positives represented the majority of the isolates. Gastric pH was neutral in the proximal pouch, whereas the distal chamber mostly but not always onserved the expected acidity. Conclusions: 1)Increased TNF-alpha and TGFbeta production, as aerobes, anaerobes and fungi colonization of both gastric chambers was detected; 2) Gastric pH as well as bacterial count was higher in the functioning proximal stomach; 3) Breath test was positive for bacterial overgrowth in 40.5% of the subjects, however clinical manifestation of GI bacterial overgrowth were not demonstrated
 
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Publishing Date
2008-01-17
 
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