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14-02-2024 | Proton Pump Inhibitors | Original Contributions

Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship?

Authors: Luiz H. Capaverde, Eduardo N. Trindade, Carine Leite, Carlos T. S. Cerski, Manoel R. M. Trindade

Published in: Obesity Surgery | Issue 4/2024

Abstract

Introduction

Marginal ulcers are the most prevalent endoscopic abnormality after RYGB. The etiology is still poorly understood; however, an increase in acid secretion has been strongly implicated as a causal agent. Although gastrin is the greatest stimulant of acid secretion, to date, the presence of gastrin producing G cells retained in the gastric pouch, related to the occurrence of marginal ulcers, has not been evaluated.

Objective

Evaluate the density of G cells and parietal cells in the gastric pouch of RYGB patients with a diagnosis of marginal ulcer on the post-op EGD.

Method

We retrospectively evaluated 1104 gastric bypasses performed between 2010 and 2020. Patients with marginal ulcer who met the inclusion criteria and controls were selected from this same population. Endoscopic gastric pouch biopsies were evaluated using immunohistochemical study and HE staining to assess G cell and parietal cell density.

Results

In total, 572 (51.8%) of the patients performed endoscopic follow-up after RYGB. The incidence of marginal ulcer was 23/572 (4%), and 3 patients required revision surgery due to a recalcitrant ulcer. The mean time for ulcer identification was 24.3 months (2–62). G cell count per high-power field (× 400) was statistically higher in the ulcer group (p < 0.05). There was no statistical difference in parietal cell density between groups (p 0.251).

Conclusion

Patients with a marginal ulcer after gastric bypass present a higher density of gastrin-producing G cells retained in the gastric pouch.

Graphical Abstract

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Title: Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship?
Authors: Luiz H. Capaverde
Eduardo N. Trindade
Carine Leite
Carlos T. S. Cerski
Manoel R. M. Trindade
Publication date: 14-02-2024
Publisher: Springer US
Keyword: Proton Pump Inhibitors
Published in: Obesity Surgery / Issue 4/2024
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07078-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship?

Abstract

Introduction

Objective

Method

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Objective

Method

Results

Conclusion

Graphical Abstract

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