Skip to main content
Erschienen in:

Open Access 08.06.2020 | ASO Author Reflections

ASO Author Reflections: Gut Microbiome Oralization and Intestinal Inflammation After Distal Gastrectomy with Billroth II Reconstruction is Linked to Gastrointestinal Symptoms

verfasst von: Augustinas Bausys, MD, Angela Horvath, PhD

Erschienen in: Annals of Surgical Oncology | Sonderheft 3/2020

download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN
Hinweise

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Past

Long-term survivors of distal gastric cancer who underwent subtotal gastrectomy with Billroth II reconstruction (SGB2) are likely to experience gastrointestinal symptoms even years after surgery, which impacts negatively on their quality of life.1,2 The anatomical and physiological changes introduced by SGB2 suppress the gastric acid production and lead to a subsequent increase in gastric pH. This weakens the gastric barrier against food-borne and oral bacteria.3
Studies of long-term proton pump inhibitor (PPI) use (i.e. pharmacological suppression of gastric acid) have shown that a breach in gastric barrier is accompanied by very distinct changes of the microbiome that are associated with intestinal inflammation and even mortality.4 If similar changes are present after SGB2, this could be relevant for host health and long-term outcome after surgery. Therefore, we investigated if these specific changes are present in the microbiome of patients after SGB2.

Present

This cross-sectional proof-of-concept study included patients after SGB2 for early gastric cancer, and their non-gastrectomized in-house relatives as controls. Patients showed significant changes in their microbiomes compared with their relatives. These changes bore an obvious resemblance to changes observed in long-term PPI users, including an overrepresentation of Escherichia-Shigella, Enterococcus, and typical oral bacteria, such as Streptococcus, Veillonella, Oribacterium, and Mogibacterium (i.e. oralization). Furthermore, SGB2 was associated with intestinal inflammation showing an approximately 3.9-fold higher level of fecal calprotectin than their non-gastrectomized relatives. The most commonly documented gastrointestinal symptoms in gastrectomized patients were abdominal discomfort, diarrhea, and bloating, which were associated with distinct taxonomic changes of the gut microbiome.5

Future

This proof-of-concept study provided evidence for gut microbiome oralization and intestinal inflammation after SGB2. Similar to the situation in long-term PPI users, changes in the microbiome of SGB2 patients are associated with gastrointestinal symptoms, such as bloating, diarrhea, or discomfort. If longitudinal studies can confirm the causal link between SGB2 surgery and the here-described novel findings, it could introduce the gut microbiome as a new therapeutic target to improve general host health and quality of life in long-term survivors after SGB2. Microbiome-targeting therapies, such as pro- or prebiotics, fecal microbiota transplant, or even phage therapy, could be trialed to improve patients’ gastrointestinal health and reduce the severe impact of SGB2 on patients’ everyday life and well-being.

Acknowledgements

Open access funding provided by Medical University of Graz.

Disclosure

Augustinas Bausys and Angela Horvath declares no conflict of interest.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Unsere Produktempfehlungen

Die Chirurgie

Print-Titel

Das Abo mit mehr Tiefe

Mit der Zeitschrift Die Chirurgie erhalten Sie zusätzlich Online-Zugriff auf weitere 43 chirurgische Fachzeitschriften, CME-Fortbildungen, Webinare, Vorbereitungskursen zur Facharztprüfung und die digitale Enzyklopädie e.Medpedia.

e.Med Interdisziplinär

Kombi-Abonnement

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

Literatur
1.
Zurück zum Zitat 1. Yu W, Park KB, Chung HY, Kwon OK, Lee SS. Chronological changes of quality of life in long-term survivors after gastrectomy for gastric cancer. Cancer Res Treat. 2016;48(3):1030–6.CrossRef 1. Yu W, Park KB, Chung HY, Kwon OK, Lee SS. Chronological changes of quality of life in long-term survivors after gastrectomy for gastric cancer. Cancer Res Treat. 2016;48(3):1030–6.CrossRef
2.
Zurück zum Zitat 2. Brenkman HJF, Tegels JJW, Ruurda JP, Luyer MDP, Kouwenhoven EA, Draaisma WA, et al. Factors influencing health-related quality of life after gastrectomy for cancer. Gastric Cancer. 2018;21(3):524–32.CrossRef 2. Brenkman HJF, Tegels JJW, Ruurda JP, Luyer MDP, Kouwenhoven EA, Draaisma WA, et al. Factors influencing health-related quality of life after gastrectomy for cancer. Gastric Cancer. 2018;21(3):524–32.CrossRef
3.
Zurück zum Zitat 3. Carboni M, Guadagni S, Pistoia MA, Amicucci G, Tuscano D, Negro P, et al. The microflora of the gastric juice after billroth I and billroth II partial gastrectomy. Scand J Gastroenterol. 1986;21(4):461–70.CrossRef 3. Carboni M, Guadagni S, Pistoia MA, Amicucci G, Tuscano D, Negro P, et al. The microflora of the gastric juice after billroth I and billroth II partial gastrectomy. Scand J Gastroenterol. 1986;21(4):461–70.CrossRef
4.
Zurück zum Zitat 4. Horvath A, Rainer F, Bashir M, Leber B, Schmerboeck B, Klymiuk I, et al. Biomarkers for oralization during long-term proton pump inhibitor therapy predict survival in cirrhosis. Sci Rep. 2019;9(1):12000CrossRef 4. Horvath A, Rainer F, Bashir M, Leber B, Schmerboeck B, Klymiuk I, et al. Biomarkers for oralization during long-term proton pump inhibitor therapy predict survival in cirrhosis. Sci Rep. 2019;9(1):12000CrossRef
Metadaten
Titel
ASO Author Reflections: Gut Microbiome Oralization and Intestinal Inflammation After Distal Gastrectomy with Billroth II Reconstruction is Linked to Gastrointestinal Symptoms
verfasst von
Augustinas Bausys, MD
Angela Horvath, PhD
Publikationsdatum
08.06.2020
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe Sonderheft 3/2020
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08703-3

Neu im Fachgebiet Chirurgie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Appendizitis und Darminfarkt durch Blinddarm-Lipom

Eigentlich sind Lipome recht harmlos. Im Zäkum können sie jedoch erhebliche Komplikationen mit Darminfarkt und Appendizitis verursachen.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

MedTalk Leitlinie KOMPAKT: S3-Leitline zu peripheren Nervenverletzungen

  • Webinar | 10.02.2025 | 13:00

Über den Weg zur finalen Fassung der S3-Leitlinie "Versorgung peripherer Nervenverletzungen" sprechen Prof. Dr. Leila Harhaus-Wähner und Ressortleiter Dr. Gunter Freese im WebTalk Leitlinie KOMPAKT, einer neuen Webcast-Serie von SpringerMedizin passend zu Ihrem Fachmagazin Orthopädie und Unfallchirurgie Mitteilungen und Nachrichten. In dem kurzen Video geht es darum, was sich im Vergleich zur vorigen Fassung der Leitlinie geändert hat, welche Aspekte für die tägliche Praxis besonders wichtig sind und was jeder gemäß Leitlinie nun anders oder besser machen sollte.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.