The relationship between metabolic and gastric histopathology findings i̇n patients undergoing bariatric surgery

Aim: The aim of this study was to investigate the relationship between gastric histopathology and metabolic features of patients with morbid obesity who underwent sleeve gastrectomy. In addition, non-obese subjects were compared with gastric histopathology findings. Method: 269 patients diagnosed with morbid obesity who applied to Zonguldak Bulent Ecevit University Health Application and Research Center, Department of Internal Medicine, Endocrinology and Metabolic Diseases outpatient clinic between 2013 and 2018, underwent eve sleeve gastrectomy ve and were included in the study. Demographic, clinical, biochemical and histopathological findings of gastrectomy specimens according to Sydney calcification were determined. In the same years 88 non-obese cases (body mass index, BMI> 30 kg / m2) who don't have significant metabolic disease[diabetes mellitus (DM), hypertension (HT)],admitted Gastroenterology endoscopy unit and gastric biopsy was performed also reached histopathological findings were taken as control group. The demographic, anthropometric, clinical findings, metabolic disorders and biochemical (LDL-c, HDL-c, triglyceride, total cholesterol, FBS, TSH) data of patients underwent sleeve gastrectomy were compared with non-obese control group using SPSS 19. 0 program. Results: The majority of the morbidly obese patients who underwent sleeve gastrectomy were female sex (73. 6%). The mean age of this group was 38. 89 ± 10. 42 years and the mean BMI was 47. 11 ± 6. 33 kg / m2. 21. 6% of the patients were under treatment with the diagnosis of type 2 DM. In addition, 27. 9% had HT, 11% had hypothyroidism and 2. 6% had coronary artery disease. The majority of (85. 7%) histopathological examinations of gastrectomy were defined as chronic gastritis. According to the Sydney classification, the majority of cases had Helicobacter pylori (HP) and chronic inflammation (75. 8% and 85. 1%, respectively). When the patients were grouped as HP positive and negative, total cholesterol, triglyceride, LDL-k levels were higher in HP positive group than HP negative group. Only total cholesterol averages were statistically significant (p <0. 05). In the HP positive group, mean waist circumference, fasting blood sugar, fasting plasma insulin levels, ALT, TSH levels and systolic and diastolic blood pressure were high. However, the differences of these data were not statistically significant (p> 0.05). The mean waist circumference of neutrophil activity positive patients in morbidly obese patients was statistically significant (p <0. 05). Mean age was similar when compared to the non-obese control group (p> 0. 05). The female gender ratio, BMI and triglyceride mean of the morbidly obese group were statistically significant (73. 8% and 44. 3% p <0. 05; 47. 26 ± 6. 47 kg / m2 and 23. 37 ± 2 respectively). 9 kg / m2 and p <0. 001; 168. 56 ± 112. 68 mg / dl and 127. 42 ± 74. 47 mg / dl, p <0. 001). In our study, the incidence of metaplasia and atrophy was significantly higher in the non-obese control group (p <0.05 and p <0. 05, respectively). However, the incidence of intestinal metaplasia and glandular atrophy was 12. 6% and 2. 6%, respectively, in our morbidly obese patient group, including the young age group. The rate of intestinal metaplasia, which is known to increase with age, was found to be very high in similar studies. Helicobacter pylori positivity rate was significantly higher in the morbidly obese group compared to the control group (p <0. 001); Helicobacter pylori positive cases were four times more morbidly obese (Odds Ratio, 4; 95% CI, 2. 29-6. 99). Conclusion: As seen in our study, pre-cancerous findings such as intestinal metaplasia, glandular atrophy and Helicobacter pylori positivity are found in high rates in morbid obese patients who underwent sleeve gastrectomy. Helicobacter pylori positivity was higher in the morbidly obese group than in the non-obese control group. The role of Helicobacter pylori in the pathophysiology of the development of morbid obesity should be considered and the necessity of eradication in the treatment of obesity should be considered. Histopathological examination of the material to be obtained before and / or after sleeve gastrectomy according to Sydney calcification must be considered.