Histopathological Findings in Morbid Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Does H. pylori Infection Effective on Pathological Changes?
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To determine the prevalence of histopathological findings requiring clinical follow-up in morbidly obese patients undergoing laparoscopic sleeve gastrectomy (LSG) and evaluate the relationship between these findings and Helicobacter pylori as well as to add more data to the published literature in this regard.
Materıal and Methods
Overall, 161 morbidly obese patients with body mass index (BMI) > 40 kg/m2 who underwent LSG between May 1, 2014 and May 31, 2017 were retrospectively included in the study. The findings of the histopathological evaluation of the resected gastric material and the relationship between these findings and histopathologically detected H. pylori infection were investigated.
The study included 114 women (70.8%) and 47 men (29.2%). The mean age of the patients was 36.82 ± 10.41 years, and the mean BMI was 46.05 ± 3.76 kg/m2. H. pylori infection was detected in 103 (64%), chronic gastritis in 156, chronic active gastritis in 47, intestinal metaplasia in eight, and atrophy in seven patients. The rate of H. pylori-associated chronic gastritis was 64%, that of chronic active gastritis was 24.2%, that of lymphoid aggregation was 62.2%, and that of intestinal metaplasia and atrophy was 3.1%. There was a significant relationship between H. pylori infection and chronic gastritis, chronic active gastritis, and lymphoid aggregation; however, no significant relationship was found between intestinal metaplasia and atrophy.
Clinicians should be aware of the histopathological findings requiring clinical follow-up for LSG-treated patients. Given the complications of H. pylori infection such as lymphoma and malignancy, periodic follow-up of patients and eradication therapy may be a suitable approach for treating intestinal metaplasia and atrophic changes.
KeywordsMorbid obesity Sleeve gastrectomy Stomach Histopathological examination H. pylori
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
- 1.Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6(6):707–13.Google Scholar
- 3.Che J, Wu Y, Mui L, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9.Google Scholar
- 4.Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med. 1994;330(18):1267–71.Google Scholar
- 6.Aydemir S, Bayraktaroglu T, Sert M, et al. The effect of helicobacter pylori on insulin resistance. Dig Dis Sci. 2005;50(11):2090–3.Google Scholar
- 8.Clapp B. Histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS. 2015;19(1):2013–5.Google Scholar
- 9.Almazeedi S, Al-sabah S, Al-mulla A, et al. Gastric Histopathologies in patients undergoing laparoscopic sleeve Gastrectomies. Obes Surg. 2013;2015:314–9.Google Scholar
- 10.Safaan T, Bashah M, El AW, et al. Histopathological changes in laparoscopic sleeve gastrectomy specimens : prevalence, risk factors, and value of routine histopathologic examination. Obes Surg. 2017;27(7):1741–9.Google Scholar
- 11.Franklin AL, Koeck ES, Hamrick MC, et al. Prevalence of chronic gastritis or helicobacter pylori infection in adolescent sleeve gastrectomy patients Does not correlate with symptoms or surgical outcomes. Surg Infect. 2015;16(4):401–4.Google Scholar
- 12.Yardimci E, Bozkurt S, Baskoy L, et al. Rare entities of histopathological findings in 755 sleeve gastrectomy cases : a synopsis of preoperative endoscopy findings and histological evaluation of the specimen. Obes Surg. 2017; https://doi.org/10.1007/s11695-017-3014-x.
- 13.Dogan U, Suren D, Oruc MT, et al. Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy. Eur Rev Med Pharmacol Sci. 2017;21(23):5430–6.Google Scholar
- 14.Raess PW, Baird-Howell M, Aggarwal R, et al. Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Relat Dis. 2015;11(5):1020–3.Google Scholar
- 16.Rossetti G, Moccia F, Marra T, et al. Does helicobacter pylori infection have influence on outcome of laparoscopic sleeve gastrectomy for morbid obesity ? Int J Surg. 2014;12(Suppl 1):S68–71.Google Scholar
- 17.Rath-wolfson L, Varona R, Bubis G, et al. Gastritis in patients undergoing sleeve gastrectomy. Medicine (Baltimore). 2017 Apr;96(16):e6602. https://doi.org/10.1097/MD.0000000000006602.
- 18.Onzi TR, d'Acampora AJ, de Araújo FM, et al. Gastric histopathology in laparoscopic sleeve gastrectomy: pre- and post-operative comparison. Obes Surg. 2014;24:371–6.Google Scholar
- 19.Danciu M, Simion L, Poroch V, et al. The role of histological evaluation of helicobacter pylori infection in obese patients referred to laparoscopic sleeve gastrectomy. Romanian J Morphol Embryol. 2016;57(4):1303–11.Google Scholar
- 22.Nouraie M, Latifi-navid S, Rezvan H, et al. Childhood hygienic practice and family education status determine the prevalence of helicobacter pylori infection in Iran. Helicobacter. 2009;14(1):40–6.Google Scholar
- 23.Bor S, Vardar R, Ormeci N, et al. Prevalence patterns of gastric cancers in Turkey: model of a developing country with high occurrence of helicobacter pylori. J Gastroenterol Hepatol. 2007;22(12):2242–5.Google Scholar
- 26.Kara N, Urganci N, Kalyoncu D, et al. The association between helicobacter pylori gastritis and lymphoid aggregates, lymphoid follicles and intestinal metaplasia in gastric mucosa of children. J Paediatr Child Health. 2014;50(8):605–9.Google Scholar