ABSTRACT
ABSTRACT BACKGROUND: Enteroendocrine L cells can be found in the entire gastrointestinal tract and their incretins act on glycemic control and metabolic homeostasis. Patients with severe obesity and type 2 diabetes mellitus may have lower density of L cells in the proximal intestine. AIMS: This study aimed to analyze the density of L cells in the segments of the small intestine in the late postoperative of Roux-en-Y gastric bypass in diabetic patients with standardization of 60 cm in both loops, alimentary and biliopancreatic. METHODS: Immunohistochemistry analysis assays were made from intestinal biopsies in three segments: gastrointestinal anastomosis (GIA= Point A), enteroenteral anastomosis (EEA= Point B= 60 cm distal to the GIA) and 60 cm distal to the enteroenteral anastomosis (Point C). RESULTS: A higher density of L cells immunostaining the glucagon-1 peptide was observed in the distal portion (Point C) when compared to the more proximal portions (Points A and B). CONCLUSIONS: The concentration of L cells is higher 60 cm distal to enteroenteral anastomosis when comparing to proximal segments and may explain the difference in intestinal lumen sensitization and enterohormonal response after Roux-en-Y gastric bypass.
RESUMO RACIONAL: As células L enteroendócrinas podem ser encontradas na extensão de todo trato gastrointestinal e suas incretinas atuam no controle glicêmico e da homeostase metabólica. Estudos mostram que pacientes obesos graves com diabetes mellitus tipo 2 apresentam má sinalização entero-hormonal e baixa resposta da secreção do peptídeo glucagon-1, que poderia ser explicado por uma densidade menor de células L ou uma distribuição mais distal ao longo do intestino delgado. OBJETIVOS: Analisar a diferença da densidade de células L nos segmentos do intestino delgado de pacientes obesos graves submetidos à gastroplastia em Y de Roux, em período pós-operatório tardio, com padronização de alça alimentar e biliopancreática com extensão de 60 cm em ambas. MÉTODOS: Ensaios de análises de imuno-histoquímica foram feitos a partir de biopsias intestinais obtidas em três segmentos: junto à anastomose gastrointestinal (AGI= Ponto A), junto à anastomose entero-enteral (AEE= Ponto B= 60 cm distal à AGI) e 60 cm distalmente à anastomose entero-enteral (Ponto C). Os resultados foram obtidos por meio de imunomarcação do peptídeo glucagon-1 secretado pelas células L. RESULTADOS: Foi observada maior densidade de células L na porção mais distal do intestino delgado (Ponto C) quando comparada às porções mais proximais (Ponto A e B). CONCLUSÕES: Em pacientes no pós-operatório de gastroplastia em Y de Roux, identificou-se concentração maior de células L já na porção a 60 cm distalmente a entero-entero anastomose quando comparada aos segmentos proximais, o que pode explicar diferenças na sensibilização no lúmen intestinal e na resposta entero-hormonal.
ABSTRACT
OBJECTIVES: Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS: We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS: The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION: Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.