Original Article
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World J Gastroenterol. May 21, 2013; 19(19): 2904-2912
Published online May 21, 2013. doi: 10.3748/wjg.v19.i19.2904
Effect of growth hormone, hyperbaric oxygen and combined therapy on the gastric serosa
Gokhan Adas, Mine Adas, Soykan Arikan, Ahu Kemik Sarvan, Akin Savas Toklu, Selva Mert, Gul Barut, Sedat Kamali, Bora Koc, Firat Tutal
Gokhan Adas, Bora Koc, Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey
Mine Adas, Department of Endocrinology, Okmeydani Training and Research Hospital, 34384 Istanbul, Turkey
Soykan Arikan, Department of Surgery, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey
Ahu Kemik Sarvan, Department of Biochemistry, Istanbul Faculty of Medicine, 34091 Istanbul, Turkey
Akin Savas Toklu, Selva Mert, Department of Underwater and Hyperbaric Medicine, Istanbul Faculty of Medicine, 34091 Istanbul, Turkey
Gul Barut, Department of Pathology, Haseki Training and Research Hospital, 34096 Istanbul, Turkey
Sedat Kamali, Firat Tutal, Department of Surgery, Okmeydani training and Research Hospital, 34384 Istanbul, Turkey
Author contributions: Adas G, Adas M and Arikan S performed the majority of experiments; Koc B, Sarvan AK, Toklu AS and Barut G provided vital reagents and analytical tools and were also involved in editing the manuscript; Kamali S and Tutal F designed the study and wrote the manuscript.
Correspondence to: Bora Koc, MD, Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, 11 Tevfik Saglam Ave, Zuhuratbaba, Bakirkoy, 34147 Istanbul, Turkey. drborakoc@hotmail.com
Telephone: +90-533-4948090 Fax: +90-212-2217777
Received: November 5, 2012
Revised: December 13, 2012
Accepted: January 11, 2013
Published online: May 21, 2013

AIM: To investigate the role of growth hormone (GH), hyperbaric oxygen therapy (HBOT) and combined therapy on the intestinal neomucosa formation of the gastric serosa.

METHODS: Forty-eight male Wistar-albino rats, weighing 250-280 g, were used in this study. The rats were divided into four groups (n = 12): Group 1, control, gastric serosal patch; Group 2, gastric serosal patch + GH; Group 3, gastric serosal patch + HBOT; and Group 4, gastric serosal patch + GH + HBOT. Abdominal access was achieved through a midline incision, and after the 1-cm-long defect was created in the jejunum, a 1 cm × 1 cm patch of the gastric corpus was anastomosed to the jejunal defect. Venous blood samples were taken to determine the insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) basal levels. HBOT was performed in Groups 3 and 4. In Groups 2 and 4, human GH was given subcutaneously at a dose of 2 mg per kg/d for 28 d, beginning on the operation day. All animals were sacrificed 60 d after surgery. The jejunal segment and the gastric anastomotic area were excised for histological examination. The inflammatory process, granulation, collagen deposition and fibroblast activity at the neomucosa formation were studied and scored. Additionally, the villus density, villus height, and crypt depth were counted and recorded. The measurements of villus height and crypt depth were calculated with an ocular micrometer. New vessel growth was determined by calculatingeach new vessel in a 1 mm2 area.

RESULTS: In the histological comparison of groups, no significant differences were observed between the control group and Groups 2 and 3 with respect to epithelialization, granulation, fibroblastic activity and the inflammatory process, but significant differences were present between the control group and all others groups (Groups 2-4) with respect to angiogenesis (P < 0.01) and collagen deposition (P < 0.05, P < 0.01). Significant differences between the control group and Group 4 were also observed with respect to epithelialization and fibroblastic activity (P < 0.01 and P < 0.05, respectively). There were significant differences in villus density in all of groups compared with the control group (P < 0.05). Crypt depth was significantly greater in Group 4 than in the control group (P < 0.05), but no other groups had deeper crypts. However, villus height was significantly longer in Groups 2 and 4 than in the control group (P < 0.05). The comparison of groups revealed, significant difference between control group and Groups 2 and 4) with respect to the levels of IGF-1 and IGFBP-3 (P < 0.01) 3 wk after the operation.

CONCLUSION: HBOT or GH and combined therapy augmented on neomucosal formation. The use of combined therapy produced a synergistic effect on the histological, morphological and functional parameters.

Keywords: Growth hormone, Hyperbaric oxygen, Neomucosa, Short bowel syndrome, Hypoxia