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Published in: Obesity Surgery 2/2019

01-02-2019 | Original Contributions

Gut Microbiota Imbalance Can Be Associated with Non-malabsorptive Small Bowel Shortening Regardless of Blind Loop

Authors: Eduardo Lemos de Souza Bastos, Ana Maria Alvim Liberatore, Roberto Carlos Tedesco, Ivan Hong Jun Koh

Published in: Obesity Surgery | Issue 2/2019

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Abstract

Introduction

Some traditional bariatric surgery procedures may lead to functional gut shortening, which may unsettle the fine-tuned gastrointestinal physiology and affect gut microbiota balance.

Purpose

Evaluate the gut microbiota behavior in rat models facing gut shortening due to intestinal bypass.

Materials and Methods

Wistar rats (n = 17) were randomly distributed in three groups: (1) sham group (n = 5); (2) blind loop group (n = 6); and (3) resection group (n = 6). Intestinal samples and feces were analyzed to measure bacterial concentrations (small intestinal bacterial overgrowth—SIBO) 12 weeks after the experimental procedures. Bacterial translocation (BT) was investigated in the mesenteric lymph node (MLN), liver, spleen, and lung of the animals. In addition, inflammatory aspects were investigated in their liver and small bowel through histological analysis.

Results

Regardless of blind loop, gut shortening groups recorded similar high level of bacterial concentrations in intestine compartments, greater than that of the sham group (p ≤ 0.05). BT was only observed in the MLN of gut shortening models, with higher percentage in the blind loop group (p ≤ 0.05). The gut and liver histopathological analysis showed similar low-grade chronic inflammation in both gut shortening groups, likely associated with SIBO/BT events.

Conclusion

Sustained SIBO/BT was associated with proximal gut shortening in half regardless of blind loop, whereas the GI tract’s ability to restore gut microbiota balance after a surgical challenge on the small bowel appears to be linked to the functional remaining gut.
Literature
1.
go back to reference The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.CrossRef The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.CrossRef
2.
go back to reference Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018. [Epub ahead of print]. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018. [Epub ahead of print].
3.
go back to reference Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes — 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRef Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes — 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRef
4.
go back to reference English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–63. English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–63.
5.
go back to reference Ramos AC, Silva AC, Ramos MG, et al. Simplified gastric bypass: 13 years of experience and 12,000 patients operated. Arq Bras Cir Dig. 2014;27(Suppl 1):2–8.CrossRef Ramos AC, Silva AC, Ramos MG, et al. Simplified gastric bypass: 13 years of experience and 12,000 patients operated. Arq Bras Cir Dig. 2014;27(Suppl 1):2–8.CrossRef
6.
go back to reference Griffen Jr WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977;186(4):500–9.CrossRef Griffen Jr WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977;186(4):500–9.CrossRef
7.
go back to reference Nora M, Morais T, Almeida R, et al. Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes? Medicine (Baltimore). 2017;96(48):1–7.CrossRef Nora M, Morais T, Almeida R, et al. Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes? Medicine (Baltimore). 2017;96(48):1–7.CrossRef
8.
go back to reference Murad AJ, Cohen RV, de Godoy EP, et al. A prospective single-arm trial of modified long biliopancreatic and short alimentary limbs roux-En-Y gastric bypass in type 2 diabetes patients with mild obesity. Obes Surg. 2018;28(3):599–605.CrossRef Murad AJ, Cohen RV, de Godoy EP, et al. A prospective single-arm trial of modified long biliopancreatic and short alimentary limbs roux-En-Y gastric bypass in type 2 diabetes patients with mild obesity. Obes Surg. 2018;28(3):599–605.CrossRef
9.
go back to reference Liou AP, Paziuk M, Luevano Jr JM, et al. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5:178ra141.CrossRef Liou AP, Paziuk M, Luevano Jr JM, et al. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5:178ra141.CrossRef
10.
go back to reference Kong LC, Tap J, Aron-Wisnewsky J, et al. Gut microbiota after gastric bypass in human obesity: increased richness and associations of bacterial genera with adipose tissue genes. Am Soc Nutr. 2013;98:16–24. Kong LC, Tap J, Aron-Wisnewsky J, et al. Gut microbiota after gastric bypass in human obesity: increased richness and associations of bacterial genera with adipose tissue genes. Am Soc Nutr. 2013;98:16–24.
11.
go back to reference Osto M, Abegg K, Bueter M, et al. Roux-en-Y gastric bypass surgery in rats alters gut microbiota profile along the intestine. Physiol Behav. 2013;119:92–6.CrossRef Osto M, Abegg K, Bueter M, et al. Roux-en-Y gastric bypass surgery in rats alters gut microbiota profile along the intestine. Physiol Behav. 2013;119:92–6.CrossRef
12.
go back to reference Tremaroli V, Karlsson F, Werling M, et al. Roux-en-Y gastric bypass and vertical banded gastroplasty induce long-term changes on the human gut microbiome contributing to fat mass regulation. Cell Metab. 2015;22:228–38.CrossRef Tremaroli V, Karlsson F, Werling M, et al. Roux-en-Y gastric bypass and vertical banded gastroplasty induce long-term changes on the human gut microbiome contributing to fat mass regulation. Cell Metab. 2015;22:228–38.CrossRef
13.
go back to reference Palleja A, Kashani A, Allin KH, et al. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota. Genome Med. 2016;8(1):67.CrossRef Palleja A, Kashani A, Allin KH, et al. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota. Genome Med. 2016;8(1):67.CrossRef
14.
go back to reference Lee YK, Mazmanian SK. Has the microbiota played a critical role in the evolution of the adaptive immune system? Science. 2010;330(6012):1768–73.CrossRef Lee YK, Mazmanian SK. Has the microbiota played a critical role in the evolution of the adaptive immune system? Science. 2010;330(6012):1768–73.CrossRef
15.
go back to reference Cho I, Blaser MJ. The human microbiome: at the interface of health and disease. Nat Rev Genet. 2012;13(4):260–70.CrossRef Cho I, Blaser MJ. The human microbiome: at the interface of health and disease. Nat Rev Genet. 2012;13(4):260–70.CrossRef
16.
go back to reference Clemente JC, Ursell LK, Parfrey LW, et al. The impact of the gut microbiota on human health: an integrative view. Cell. 2012;148(6):1258–70.CrossRef Clemente JC, Ursell LK, Parfrey LW, et al. The impact of the gut microbiota on human health: an integrative view. Cell. 2012;148(6):1258–70.CrossRef
17.
go back to reference Bures J. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978–90.CrossRef Bures J. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978–90.CrossRef
18.
go back to reference Koh IHJ, Montero E, Guatelli R, et al. Comparative study of bacterial translocation in small bowel and colon in rats. Rev Col Bras Cir. 1995;22:30–2. Koh IHJ, Montero E, Guatelli R, et al. Comparative study of bacterial translocation in small bowel and colon in rats. Rev Col Bras Cir. 1995;22:30–2.
19.
go back to reference Koh IHJ, Montero EF, Keller R, et al. Bacterial concentration versus bacterial translocation. An experimental study in rats. Rev Col Bras Cir. 1995;22:38–9. Koh IHJ, Montero EF, Keller R, et al. Bacterial concentration versus bacterial translocation. An experimental study in rats. Rev Col Bras Cir. 1995;22:38–9.
20.
go back to reference Xue H, Song D, Shi B, et al. Tracking of green fluorescent protein labeled Escherichia coli confirms bacterial translocation in blind loop rat. J Surg Res. 2007;143(2):206–10.CrossRef Xue H, Song D, Shi B, et al. Tracking of green fluorescent protein labeled Escherichia coli confirms bacterial translocation in blind loop rat. J Surg Res. 2007;143(2):206–10.CrossRef
21.
go back to reference Viddal K. Intestinal bypass. A randomized, prospective clinical study of end-to-side and end-to-end jejunoileal bypass. Scand J Gastroenterol. 1983;18(5):627–34.CrossRef Viddal K. Intestinal bypass. A randomized, prospective clinical study of end-to-side and end-to-end jejunoileal bypass. Scand J Gastroenterol. 1983;18(5):627–34.CrossRef
22.
go back to reference Rosina M, Micheletto G, Vita PM, et al. Intestinal jejunoileal microflora bypass settlement for morbid in patients obesity with. Obes Surg. 1993;3:239–45.CrossRef Rosina M, Micheletto G, Vita PM, et al. Intestinal jejunoileal microflora bypass settlement for morbid in patients obesity with. Obes Surg. 1993;3:239–45.CrossRef
23.
go back to reference Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146(6):1489–99.CrossRef Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146(6):1489–99.CrossRef
24.
go back to reference Sabaté JM, Jouët P, Harnois F, et al. High prevalence of small intestinal bacterial overgrowth in patients with morbid obesity: a contributor to severe hepatic steatosis. Obes Surg. 2008;18(4):371–7.CrossRef Sabaté JM, Jouët P, Harnois F, et al. High prevalence of small intestinal bacterial overgrowth in patients with morbid obesity: a contributor to severe hepatic steatosis. Obes Surg. 2008;18(4):371–7.CrossRef
25.
go back to reference De Minicis S, Rychlicki C, Agostinelli L, et al. Dysbiosis contributes to fibrogenesis in the course of chronic liver injury in mice. Hepatology. 2014;59(5):1738–49.CrossRef De Minicis S, Rychlicki C, Agostinelli L, et al. Dysbiosis contributes to fibrogenesis in the course of chronic liver injury in mice. Hepatology. 2014;59(5):1738–49.CrossRef
26.
go back to reference Cani PD, Neyrinck AM, Fava F, et al. Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia. Diabetologia. 2007;50(11):2374–83.CrossRef Cani PD, Neyrinck AM, Fava F, et al. Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia. Diabetologia. 2007;50(11):2374–83.CrossRef
27.
go back to reference Qin J, Li Y, Cai Z, et al. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature. 2012;490(7418):55–60.CrossRef Qin J, Li Y, Cai Z, et al. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature. 2012;490(7418):55–60.CrossRef
28.
go back to reference Ley R, Turnbaugh P, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022–3.CrossRef Ley R, Turnbaugh P, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022–3.CrossRef
29.
go back to reference Tilg H. Obesity, metabolic syndrome, and microbiota multiple interactions. J Clin Gastroenterol. 2010;44:16–8.CrossRef Tilg H. Obesity, metabolic syndrome, and microbiota multiple interactions. J Clin Gastroenterol. 2010;44:16–8.CrossRef
Metadata
Title
Gut Microbiota Imbalance Can Be Associated with Non-malabsorptive Small Bowel Shortening Regardless of Blind Loop
Authors
Eduardo Lemos de Souza Bastos
Ana Maria Alvim Liberatore
Roberto Carlos Tedesco
Ivan Hong Jun Koh
Publication date
01-02-2019
Publisher
Springer US
Published in
Obesity Surgery / Issue 2/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3540-1

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