Time-course of morphologic changes and peptide YY adaptation in ileal mucosa after loop ileostomy in humans

PURPOSE: The secretion mechanism of peptide YY involves systemic factors, such as humoral and neural stimuli, and local factors, such as intestinal peristalsis and intraluminal nutrients. This study was designed to survey the impact of local stimuli on the secretion of peptide YY under circumstances in which systemic stimuli are identical. METHODS: Ileostomies were repaired within three months in a short-term group (14 patients) and after six months in a long-term group (14 patients). Mucosal peptide YY concentrations and cytomorphologic change, such as villus height, crypt depth, mucosal thickness, and villus index, were compared between proximal functioning ileum and a distal nonfunctioning ileal loop during ileostomy repair. In a control group of patients undergoing right hemicolectomy (21 cases), the normal distribution of peptide YY was measured in the mucosa throughout the distal ileum. RESULTS: The peak of peptide YY concentration in the terminal ileum was 307.4 ± 21 pmol/g, 25 cm from the ileocecal valve, with lower levels both proximally and distally. The mucosa of the functioning ileum in the short-term group showed hypertrophy, but had returned to preoperative levels in the long-term group. The nonfunctioning mucosa in both groups underwent atrophic changes. The mucosal peptide YY content in functioning ileum in the short-term group was higher than that of distal nonfunctioning mucosa (363.9 ± 25.5 pmol/g vs. 284.1 ± 13 pmol/g, P < 0.05), suggesting adaptive upregulation. The increments of mucosal peptide YY content in this short-term group compared with the control group were 45.6 and 4.7 percent in the proximal and distal segments, respectively. In the long-term group, proximal and distal mucosal peptide YY were similar (256.6 ± 31.9 pmol/g vs. 254.9 ± 27.1 pmol/g, P > 0.05), and there was no increment in either (1.3 vs. 4.4 percent, P > 0.05). CONCLUSIONS: The peak concentrations of PYY in the ileal mucosa are found 20 to 25 cm proximal to the ileocecal valve. In the short-term response of ileostomy, local stimulatory factors play a major role in the adaptation of mucosal PYY. In the defunctioned bowel without luminal stimulation, systemic stimulation was important for maintenance of mucosal PYY.