Changes in iron transporter divalent metal transporter 1 in proximal jejunum after gastric bypass

AIM:To describe the variation that divalent metaltransporter 1(DMT1)shows in patients after Rouxen-Y gastric bypass(RYGB)surgery.METHODS:Prospective and analytical study of DMT1level at the brush border of proximal jejunum in patients having undergone RYGB surgery.The mucosa of proximal jejunum forming the gastrojejunal anastomosis was biopsied during surgery and after 6 mo later with an endoscopic biopsy.All the patients received precise instructions regarding feeding and nutritional supplementation.Both samples were processed at the same time by immunohistochemistry and western blot.Samples were analysed by a pathologist.For statistical analysis,theχ2 and Wilcoxon tests were used.RESULTS:Sixteen patients were recruited,13 of whom completed the study.Twelve were women.Average age and body mass index(BMI)were 44.1 and 40.4,respectively.Both body weight and BMI decreased significantly during the study period,with an average percent excess weight loss(%EWL)of 60%±13.3%and an average percent excess BMI loss(%EBMIL)of 79.6%±21.6%.Only two patients presented with mild anaemia6 mo after surgery,but their ferritin levels stayed within normal ranges.Staining for DMT1 showed a significant increase in the cytoplasm of enterocytes located at the tips of the villi(χ2=6.03;P=0.049).Nevertheless,the total quantity of DMT1 decreased significantly(Z=2.04;P=0.04).Associated with these results,we observed a significant increase in goblet cells in the villi 6mo postoperatively(Z=-2.47;P=0.013).CONCLUSION:Six months after RYGB surgery,patients exhibit an increase in DMT1 expression in the enterocytes of the tips of the villi at the proximal jejunum.

Hepatobiliar manifestations in inflammatory bowel disease: A practical approach

Inflammatory bowel diseases(IBD)are associated with various hepatobiliary disorders.They can occur at any moment in the course of the disease or associated with the treatment.The prevalence of liver dysfunction can reach up to 50%in different studies.Nonalcoholic fatty liver disease is considered the most common hepatobiliary complication in IBD,while primary sclerosing cholangitis is the most specific.Management of hepatic manifestations in IBD involves a multidisciplinary approach that includes a high index of suspicion and joint management with hepatologists.The medical confrontation with abnormal liver tests must include an exhaustive study to determine if these patterns can be related to IBD,associated diseases or to the therapies used.