Volume 27, Issue 7 (10-2020)
RJMS 2020, 27(7): 154-164 |
Back to browse issues page
Research code: 94-01-14-25669
Ethics code: IR.IUMS.REC
Clinical trials code: ---
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Kabir A, Pazouki A, Pishgahroudsari M, Abdolhosseini S, Faghihi-kashani A. Assessment of Pathological Findings of the Stomach in Morbid Obese Patients who are Candidates for Bariatric Surgery and the Association with Helicobacter Pylori, Biochemical Status and Inflammatory Factors. RJMS 2020; 27 (7) :154-164
URL: http://rjms.iums.ac.ir/article-1-6222-en.html
URL: http://rjms.iums.ac.ir/article-1-6222-en.html
Ali Kabir 
, Abdolreza Pazouki , Mohadeseh Pishgahroudsari , Shahrbanoo Abdolhosseini , Amirhossein Faghihi-kashani *
, Abdolreza Pazouki , Mohadeseh Pishgahroudsari , Shahrbanoo Abdolhosseini , Amirhossein Faghihi-kashani *
Iran University of Medical Sciences, Tehran, Iran , ahfaghihi@yahoo.com
Abstract: (1797 Views)
Background: Obesity and upper gastrointestinal disorders are the public health problems in the world and Iran. The role of routine preoperative upper gastrointestinal endoscopy of the morbid obese patients undergoing bariatric surgery is a subject of discussion. The aim of this study was to determine the relationship between gastric pathological findings in morbid obese patients with demographic information, Helicobacter pylori, biochemical status and inflammatory factors.
Methods: Upper digestive endoscopic findings, including rapid urease test and pathological examples in the six areas of stomach were examined in 196 morbid obese patients who were candidates for bariatric surgery. These cases had either body mass index (BMI) higher than 40 or higher than 35 in addition to one comorbidity. For grading chronic gastritis, six samples were given from these areas of stomach: two biopsies from antrum, with 2-3 centimeters (cm) from pylorus, one sample from distal of lesser curvature, another one from distal of greater curvature, two samples from corpus with eight cms distance from cardia (one of them from lesser curvature another one from greater curvature) and one sample from incisura angularis according to Sydney system. Height, weight, sex, triglyceride (TG), cholesterol (Chol), high density lipoprotein (HDL), low density lipoprotein (LDH), fasting blood sugar (FBS), and history of some diseases (hypothyroidism, lipid profile metabolism disorders, diabetes mellitus type II, sleep apnea, menstrual abnormalities, and eating disorders) were evaluated as well. We get six samples from three areas of the stomach for grading chronic gastritis according to Sydney system: two biopsy samples from pylorus, by 2-3 cm from pylorus, one from distal of lesser curvature, one from distal of greater curvature, two sample from cardia, with eight cm distance from cardia (one from lesser and the other from greater curvature), and one sample from incisura angularis. T-test, chi-square and Fisher exact test were used in statistical analysis. This study was approved by ethics committee of Iran University of Medical Sciences by this code: 25669.1396 IR.IUMS.REC.
Results: There were 86.2% women among all 196 cases. Mean ± standard deviation (SD) of age, weight and BMI of participants were 39.9±10.2 years, 123.5±22.5 kilogram (Kg), and 45.9±6.1 kg/m2, respectively. Smoking in 15.8% and alcohol drinking in 13.8% was observed. Dyslipidemia in 44 (22.4%), hypothyroidism in 42 (21.4%), menstrual abnormality in 39 (19.9%), diabetes mellitus in 26 (13.3%) and sleep apnea in 21 cases (10.7%) were the most common comorbidities in these patients. Family history of obesity: 161 (88.2%), hypertension: 121 (61.7%), diabetes mellitus: 113 (57.7%) and cancer: 64 patients (32.7%) were the most common diseases in family of affected patients. Eating disorders were volume eating in 161 (82.1%), microphagia in 129 (65.8%) and bulimia in 121 cases (61.7%), respectively in descending order.
The most common pathologic findings of the stomach were chronic inflammation in 195 (99.5%), acute inflammation in 131 (66.8%), active inflammation in 127 (64.8%), H. pylori infection in 120 (61.2%), active atrophy in 37 (18.9%), metaplasia in 29 (14.8%) and atypia in 19 cases (9.7%), respectively. There was not any cases with dysplasia. The most common H. pylori prevalence was in incisura in 116 cases (59.2%), while, the lowest prevalence was observed in cardia in 103 patients (52.6%). Urease test for H. pylori infection was positive in 114 cases (58.2%), while, H. pylori infection in all six regions of the stomach was observed in 120 cases (61.2%). Urease test result and presence of H. pylori infection had statistically significant association with each other (p<0.001). In 27 cases (22.5%) despite H. pylori infection in pathologic assessment from biopsy samples of one of six regions of the stomach, urease test was falsely negative. On the other hand, in 21 samples (27.6%) despite negative result for H. pylori in all six areas of the stomach, urease was falsely positive. The specificity and sensitivity of rapid urease test were calculated to be 72.4% and 77.5%, respectively. Demographic information, biochemical status and inflammatory factors of the two groups of patients with and without pathological findings in the six areas of stomach were not different (For all of them p>0.050). However, the presence of Helicobacter pylori was associated with pathology finding in only two areas: small corpus and large corpus (p= 0.006 and p<0.001, respectively).
Conclusion: In our study abnormal findings in endoscopy was higher than similar studies. Positive result of urease test was also higher because similar studies have excluded symptomatic cases with gastroesophageal reflux disease and PPI users. The role of routine upper gastrointestinal endoscopy before obesity surgery is under debate. The American Society of Gastroenterologists and Endoscopists (SAGES) recommends the American Society of Metabolic and Obesity Surgeons (ASMBS) and the American Society of Gastroenteroscopic Endoscopies that endoscopy be decided according to each individual condition and type of procedure. It is recommended in patients at high risk for gastric cancer such as a history of Helicobacter pylori, BMI, waist and waist to hip ratio, family history of gastric cancer and male sex and according to protective effects of Helicobacter pylori treatment in the prevention of gastric cancer under the age of 40. It was done to prevent pathology in at least these two areas of the stomach in the future. However, showing the presence of Helicobacter pylori with pathology in these two areas of the stomach in this study does not mean that if Helicobacter pylori is eradicated, the chance of developing gastric cancer in these areas will be zero; Other studies have not shown that Helicobacter pylori infection is associated with pathology in any part of the stomach due to the lack of gastric mapping, so it is likely that what has been said about eradicating Helicobacter pylori and reducing the chance of stomach cancer. It has been due to the eradication of Helicobacter pylori in two areas of small corpus and large corpus of the stomach. According to the association of Helicobacter pylori infection and pathological findings in small corpus and large corpus areas of stomach and the results of other studies that Helicobacter pylori infection increases the chance of gastric cancer and due to high false negative rate of rapid urease test (22.5%) It is recommended that for patients with high risk of gastric cancer use pathological samples, especially in these two areas, to diagnose Helicobacter pylori infection.
Methods: Upper digestive endoscopic findings, including rapid urease test and pathological examples in the six areas of stomach were examined in 196 morbid obese patients who were candidates for bariatric surgery. These cases had either body mass index (BMI) higher than 40 or higher than 35 in addition to one comorbidity. For grading chronic gastritis, six samples were given from these areas of stomach: two biopsies from antrum, with 2-3 centimeters (cm) from pylorus, one sample from distal of lesser curvature, another one from distal of greater curvature, two samples from corpus with eight cms distance from cardia (one of them from lesser curvature another one from greater curvature) and one sample from incisura angularis according to Sydney system. Height, weight, sex, triglyceride (TG), cholesterol (Chol), high density lipoprotein (HDL), low density lipoprotein (LDH), fasting blood sugar (FBS), and history of some diseases (hypothyroidism, lipid profile metabolism disorders, diabetes mellitus type II, sleep apnea, menstrual abnormalities, and eating disorders) were evaluated as well. We get six samples from three areas of the stomach for grading chronic gastritis according to Sydney system: two biopsy samples from pylorus, by 2-3 cm from pylorus, one from distal of lesser curvature, one from distal of greater curvature, two sample from cardia, with eight cm distance from cardia (one from lesser and the other from greater curvature), and one sample from incisura angularis. T-test, chi-square and Fisher exact test were used in statistical analysis. This study was approved by ethics committee of Iran University of Medical Sciences by this code: 25669.1396 IR.IUMS.REC.
Results: There were 86.2% women among all 196 cases. Mean ± standard deviation (SD) of age, weight and BMI of participants were 39.9±10.2 years, 123.5±22.5 kilogram (Kg), and 45.9±6.1 kg/m2, respectively. Smoking in 15.8% and alcohol drinking in 13.8% was observed. Dyslipidemia in 44 (22.4%), hypothyroidism in 42 (21.4%), menstrual abnormality in 39 (19.9%), diabetes mellitus in 26 (13.3%) and sleep apnea in 21 cases (10.7%) were the most common comorbidities in these patients. Family history of obesity: 161 (88.2%), hypertension: 121 (61.7%), diabetes mellitus: 113 (57.7%) and cancer: 64 patients (32.7%) were the most common diseases in family of affected patients. Eating disorders were volume eating in 161 (82.1%), microphagia in 129 (65.8%) and bulimia in 121 cases (61.7%), respectively in descending order.
The most common pathologic findings of the stomach were chronic inflammation in 195 (99.5%), acute inflammation in 131 (66.8%), active inflammation in 127 (64.8%), H. pylori infection in 120 (61.2%), active atrophy in 37 (18.9%), metaplasia in 29 (14.8%) and atypia in 19 cases (9.7%), respectively. There was not any cases with dysplasia. The most common H. pylori prevalence was in incisura in 116 cases (59.2%), while, the lowest prevalence was observed in cardia in 103 patients (52.6%). Urease test for H. pylori infection was positive in 114 cases (58.2%), while, H. pylori infection in all six regions of the stomach was observed in 120 cases (61.2%). Urease test result and presence of H. pylori infection had statistically significant association with each other (p<0.001). In 27 cases (22.5%) despite H. pylori infection in pathologic assessment from biopsy samples of one of six regions of the stomach, urease test was falsely negative. On the other hand, in 21 samples (27.6%) despite negative result for H. pylori in all six areas of the stomach, urease was falsely positive. The specificity and sensitivity of rapid urease test were calculated to be 72.4% and 77.5%, respectively. Demographic information, biochemical status and inflammatory factors of the two groups of patients with and without pathological findings in the six areas of stomach were not different (For all of them p>0.050). However, the presence of Helicobacter pylori was associated with pathology finding in only two areas: small corpus and large corpus (p= 0.006 and p<0.001, respectively).
Conclusion: In our study abnormal findings in endoscopy was higher than similar studies. Positive result of urease test was also higher because similar studies have excluded symptomatic cases with gastroesophageal reflux disease and PPI users. The role of routine upper gastrointestinal endoscopy before obesity surgery is under debate. The American Society of Gastroenterologists and Endoscopists (SAGES) recommends the American Society of Metabolic and Obesity Surgeons (ASMBS) and the American Society of Gastroenteroscopic Endoscopies that endoscopy be decided according to each individual condition and type of procedure. It is recommended in patients at high risk for gastric cancer such as a history of Helicobacter pylori, BMI, waist and waist to hip ratio, family history of gastric cancer and male sex and according to protective effects of Helicobacter pylori treatment in the prevention of gastric cancer under the age of 40. It was done to prevent pathology in at least these two areas of the stomach in the future. However, showing the presence of Helicobacter pylori with pathology in these two areas of the stomach in this study does not mean that if Helicobacter pylori is eradicated, the chance of developing gastric cancer in these areas will be zero; Other studies have not shown that Helicobacter pylori infection is associated with pathology in any part of the stomach due to the lack of gastric mapping, so it is likely that what has been said about eradicating Helicobacter pylori and reducing the chance of stomach cancer. It has been due to the eradication of Helicobacter pylori in two areas of small corpus and large corpus of the stomach. According to the association of Helicobacter pylori infection and pathological findings in small corpus and large corpus areas of stomach and the results of other studies that Helicobacter pylori infection increases the chance of gastric cancer and due to high false negative rate of rapid urease test (22.5%) It is recommended that for patients with high risk of gastric cancer use pathological samples, especially in these two areas, to diagnose Helicobacter pylori infection.
Keywords: Pathological findings, Gastric, Morbid obesity, Bariatric surgery, Inflammatory factors, Helicobacter pylori
Type of Study: Research |
Subject:
Gastroentrology
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
