Razi Journal of Medical Sciences

fa ارزیابی یافته های پاتولوژیک در معده بیماران چاق مفرط کاندید عمل جراحی چاقی و بررسی ارتباط آن با هلیکوباکتر پیلوری، پارامترهای بیوشیمیایی وفاکتورهای التهابی 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 گوارش Gastroentrology پژوهشي Research <div dir="RTL"> <div> <div id="_com_8" uage="JavaScript">زمینه و هدف: چاقی و مشکلات دستگاه گوارش فوقانی از مهم‌ترین مشکلات بهداشت عمومی در جهان و ایران هستند. همچنین نقش اندوسکوپی روتین دستگاه گوارش فوقانی قبل جراحی چاقی مورد بحث است. این مطالعه با هدف تعیین ارتباط بین یافته‌های پاتولوژیک در هر یک از نواحی 6 گانه معده در بیماران چاق مفرط با عفونت هلیکوباکتر پیلوری، فاکتورهای بیوشیمیایی و التهابی طراحی شده است. روش کار: یافته‌های آندوسکوپیک شامل نمونه اوره آز و نمونه‌های پاتولوژیک در نواحی 6 گانه معده در 196 بیمار چاق مفرط کاندید عمل جراحی چاقی مورد بررسی قرار گرفت. یافته‌ها: اطلاعات دموگرافیک، وضعیت بیوشیمیایی، فاکتورهای التهابی در دو گروه از بیماران، با وجود و عدم وجود یافته‌های پاتولوژیک در هر یک از نواحی 6 گانه معده هیچگونه اختلافی نداشتند (برای همه آنها 050/0p >). وجود هلیکوباکتر پیلوری با وجود پاتولوژی فقط در دو ناحیه Small corpus و Large corpus همراهی داشت (به ترتیب 006/0=p و 001/0>p). ویژگی و حساسیت تست اوره آز به ترتیب 4/72% و 5/77% محاسبه شد. نتیجه‌گیری: به دلیل همراهی وجود عفونت هلیکوباکتر پیلوری و یافته‌های پاتولوژی در دو ناحیه تنه کوچک و بزرگ معده (Small corpus و large corpus) و نتایج حاصل از سایر مطالعات که عفونت هلیکوباکتر پیلوری شانس ابتلا به سرطان معده را افزایش می‌دهد و با توجه به موارد منفی کاذب بالای تست اوره آز (5/22% موارد) توصیه می شود در بیمارانی که ریسک بالایی از نظر سرطان معده دارند از نمونه‌های پاتولوژی به خصوص در این دو ناحیه، برای تشخیص استفاده کرد تا با صحت تشخیصی بالاتر، در صورت وجود عفونت هلیکوباکتر، اقدام به ریشه کنی آن نمود.</div> </div> </div> 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.   <div></div> یافته‌های پاتولوژیک,معده,چاق مفرط,جراحی باریتریک,فاکتورهای التهابی,عفونت هلیکوباکتر پیلوری Pathological findings, Gastric,Morbid obesity, Bariatric surgery, Inflammatory factors, Helicobacter pylori 154 164 http://rjms.iums.ac.ir/browse.php?a_code=A-10-291-3&slc_lang=fa&sid=1 Ali Kabir علی کبیر aikabir@yahoo.com 3900319475328460054422 3900319475328460054422 No Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات جراحی‌های کم تهاجمی، دانشگاه علوم پزشکی ایران، تهران، ایران Abdolreza Pazouki عبدالرضا پازوکی apazouki@yahoo.com 3900319475328460054423 3900319475328460054423 No Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات جراحی‌های کم تهاجمی، دانشگاه علوم پزشکی ایران، تهران، ایران Mohadeseh Pishgahroudsari محدثه پیشگاه رودسری mo.pishgah@gmail.com 3900319475328460054424 3900319475328460054424 No Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات جراحی‌های کم تهاجمی، دانشگاه علوم پزشکی ایران، تهران، ایران Shahrbanoo Abdolhosseini شهربانو عبدالحسینی abdolhosseinish@gmail.com 3900319475328460054425 3900319475328460054425 No Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات جراحی‌های کم تهاجمی، دانشگاه علوم پزشکی ایران، تهران، ایران Amirhossein Faghihi-kashani امیرحسین فقیهی کاشانی ahfaghihi@yahoo.com 3900319475328460054426 3900319475328460054426 Yes Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات جراحی های کم تهاجمی، دانشگاه علوم پزشکی ایران، تهران، ایران