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. 2021 Feb;28(2):1198-1208.
doi: 10.1245/s10434-020-08678-1. Epub 2020 Jun 5.

Distal Gastrectomy with Billroth II Reconstruction is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: A Proof-of-Concept Study

Angela Horvath  1 , Augustinas Bausys  2   3   4 , Rasa Sabaliauskaite  5 , Eugenijus Stratilatovas  6 , Sonata Jarmalaite  5 , Burkhard Schuetz  7 , Philipp Stiegler  8 , Rimantas Bausys  6   9 , Vanessa Stadlbauer  1 , Kestutis Strupas  9
Affiliations

Distal Gastrectomy with Billroth II Reconstruction is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: A Proof-of-Concept Study

Angela Horvath et al. Ann Surg Oncol. 2021 Feb.

Abstract

Background: Subtotal gastrectomy with Billroth II reconstruction (SGB2) results in increased gastric pH and diminished gastric barrier. Increased gastric pH following PPI therapy has an impact on the gut microbiome, intestinal inflammation, and possibly patient health. If similar changes are present after SGB2, these can be relevant for patient health and long-term outcomes after surgery. The aim of the study is to investigate whether SGB2 is associated with specific changes in gut microbiome composition and intestinal inflammation.

Patients and methods: This cross-sectional proof-of-concept study includes patients after SGB2 (n = 14) for early gastric cancer and their nongastrectomized in-house relatives as controls (n = 8). Fecal microbiome composition, intestinal inflammation (fecal calprotectin), gut permeability (DAO, LBP, sCD14), systemic inflammation (CRP) markers, and gastrointestinal symptoms are investigated. This study is registered at ClinicalTrials.gov (NCT03418428).

Results: Microbiome oralization following SGB2 was defined by an increase in Escherichia-Shigella, Enterococcus, Streptococcus, and other typical oral cavity bacteria (Veillonella, Oribacterium, and Mogibacterium) abundance. The fecal calprotectin was increased in the SGB2 group [100.9 (52.1; 292) vs. 25.8 (17; 66.5); p = 0.014], and calprotectin levels positively correlated with the abundance of Streptococcus (rs = 0.639; padj = 0.023). Gastrointestinal symptoms in SGB2 patients were associated with distinct taxonomic changes of the gut microbiome.

Conclusions: SGB2 is associated with oralization of the gut microbiome; intestinal inflammation and microbiome changes were associated with gastrointestinal symptoms. These novel findings may open gut microbiome as a new target for therapy to improve quality of life and general patient health in long-term survivors after SGB2.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Trend flowchart of enrollment
Fig. 2
Fig. 2
Changes in microbiome of SGB2 patients compared with controls: a Shannon index as a measurement of alpha diversity, b principal coordinate analysis plot based on Bray–Curtis dissimilarity, and c abundance of Escherichia–Shigella in microbiome of SGB2 patients and controls
Fig. 3
Fig. 3
LDA effect size (LEfSe) results; genera marked with an arrow previously indicated in PPI-induced or PPI-associated dysbiosis
Fig. 4
Fig. 4
Network analysis representing positive correlations between 30 most abundant genera
Fig. 5
Fig. 5
Symptom-related microbiome changes in patients after SGB2: a, b significant differences in genera of interest between patients with and without abdominal discomfort, c, d significant differences in genera of interest between patients with and without diarrhea, and e, f significant differences in genera of interest between patients with and without bloating
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References

    1. Gao J-P, Xu W, Liu W-T, Yan M, Zhu Z-G. Tumor heterogeneity of gastric cancer: from the perspective of tumor-initiating cell. World J Gastroenterol. 2018;24(24):2567–2581. doi: 10.3748/wjg.v24.i24.2567. - DOI - PMC - PubMed
    1. Marano L, Polom K, Patriti A, Roviello G, Falco G, Stracqualursi A, et al. Surgical management of advanced gastric cancer: an evolving issue. Eur J Surg Oncol. 2016;42(1):18–27. doi: 10.1016/j.ejso.2015.10.016. - DOI - PubMed
    1. Tran TB, Worhunsky DJ, Squires MH, Jin LX, Spolverato G, Votanopoulos KI, et al. To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer. Gastric Cancer. 2016;19(3):994–1001. doi: 10.1007/s10120-015-0547-3. - DOI - PubMed
    1. Huang L, Xu A-M, Li T-J, Han W-X, Xu J. Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients? World J Gastroenterol. 2014;20(22):6981. doi: 10.3748/wjg.v20.i22.6981. - DOI - PMC - PubMed
    1. Jepson K, Johnston D. Effect of vagotomy on human gastric acid secretion stimulated by gastrin pentapeptide and by histalog. Gastroenterology. 1968;55(6):665–669. doi: 10.1016/S0016-5085(19)33983-6. - DOI - PubMed

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