Exploring Vitamin B12 Deficiency in Sleeve Gastrectomy from a Histological Study of a Cadaveric Stomach and Ileum Dwaipayan Muhuri 1* , Gyorgy Nagy 2 , Velma Rawlins 3 , Lisa Sandy 3 and Peter Bellot 4 1 Ross University School of Medicine, NJ 08830, USA 2 Department of Anatomy, Ross University School of Medicine, NJ 08830, USA 3 Department of Research, Ross University School of Medicine, NJ 08830, USA 4 Department of Pathology, Ross University School of Medicine, NJ 08830, USA * Corresponding author: Dwaipayan Muhuri, BSc, MD Student, Ross University School of Medicine, 4B, 485 S Highway 1 South Iselin, NJ 08830, USA, Tel: (302) 781-2167; E-mail: dwaipayanmuhuri@students.rossu.edu Rec date: 15 June, 2016; Acc date: 19 July, 2016; Pub date: 26 July, 2016 Copyright: © 2016 Muhuri D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Introduction: Vitamin B12 Deficiency is more commonly found amongst patients who have undergone Roux-en- Y Gastric Bypasses (RYGB) as compared to those post-Sleeve Gastrectomies (SG). The major difference between SG and RYGB is that the latter greatly bypasses the stomach, whereas the former simply reduces the gastric volume. Purpose: The aim of this paper is to study the stomach and distal ileum, histologically, in a cadaver with SG to explain the higher rate of incidences of B12 deficiency seen in patient’s post-RYGB relative to patient’s post-SG. Since the stomach is the major variable in the two procedures, we hypothesize that it has the ability to regenerate and increase its surface area to compensate for the loss of its volume in SG patients. Material and Methods: Tissue biopsies and Hematoxylin and Eosin stains were performed from various anatomical locations of the GI tract, specifically, the fundus, the body, and the antrum of the stomach and from the distal ileum of the small intestine of a cadaver with SG and one without (control). Results: Compared to the control, the SG cadaver's gastric tissue biopsies were significant for chronic gastritis and hypertrophy of the muscularis externa layer. More importantly, parietal cell hyperplasia and deeper mucosal glands were also noted in the SG cadaver supporting the hypothesis. Conclusion: The compensatory role of an intact stomach, given its ability to regenerate parietal cells and increase its number in the gastric fundus and body, can be better appreciated in a gastric-sparing procedure such as SG versus RYGB in terms of limiting B12 deficiencies. Keywords: Vitamin B12 Defciency; Bariatric surgery; Gastrectomy Introduction Of the two broad categories of Bariatric surgery, gastric banding and gastric stapling, the latter is more permanent as it removes or seals of part of the stomach. Te 2 most common type of gastric stapling is Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG). From 2008 to 2011, SG procedures jumped roughly 80% to 94,689 whereas RYGB procedures actually saw a decline by 7% [1]. Of the chronic complications for SG, nutritional defciencies are of particular interest, since fewer such incidences are reported post-SG compared to post-RYGB [2]. Transformation of any part of the GI tract could have adverse efects on the body's absorption capability of nutrients including that of Vitamin B12 or Cobalamin. Defciency in Vitamin B12 can cause pernicious anemia, which can lead to fatigue and memory loss along with palpitations, dizziness, loss of appetite, numbness, vision loss, and depression. Interestingly, nutritional assessment, either through meta-analysis [3] or through pilot studies that were done worldwide including the United States [4], United Kingdom [5], and Greece [6], suggests a similar fnding when it comes to defciency of Vitamin B12 in patients afer their procedures. B12 Defciency is more commonly found amongst patients who have undergone RYGB as compared to that post-SG [3-6]. Surgically, the major diference between SG and RYGB is that the latter greatly bypasses the physiological functions of the stomach, whereas the former keeps the stomach intact but by vastly reducing its size [2]. Since the stomach is the major variable in the two procedures and plays an important role in B12 absorption as seen in Figure 1a, we hypothesize that the stomach has the ability to regenerate and increase its surface area to compensate for the loss of its volume in SG patients. Since the stomach is largely avoided as a digestive system in patients who have undergone RYGB procedures, compensation for the lack of B12 absorption would most likely be limited (Figures 1b and 1c). Te aim of this paper is to study the cadaveric stomach and distal ileum, histologically, in a patient status-post SG to explain the Journal of Nutritional Disorders & Therapy Muhuri et al., J Nutr Disorders Ther 2016, 6:3 DOI:10.4172/2161-0509.1000193 Case Report Open Access J Nutr Disorders Ter ISSN:2161-0509 JNDT, an open access journal Volume 6 • Issue 3 • 1000193