Prevalence of Helicobacter pylori in gastric specimen following laparoscopic sleeve gastrectomy

Fahad Yaslam Bamehriz

doi:10.4103/SJL.SJL_2_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 5 | Issue : 1 | Page : 27-32

Prevalence of Helicobacter pylori in gastric specimen following laparoscopic sleeve gastrectomy

Fahad Yaslam Bamehriz
Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission	12-Mar-2020
Date of Acceptance	20-Mar-2020
Date of Web Publication	3-Oct-2020

Correspondence Address:
Dr. Fahad Yaslam Bamehriz
Department of Surgery, College of Medicine, King Saud University, P. O. Box 2925, Riyadh 11461
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/SJL.SJL_2_20

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) for obese patients can give more gastric tissue that can add more precise information about Helicobacter pylori (H. pylori) presence in relation to age, gender, and body mass index (BMI).
Methodology: We retrospectively collected the computerized data and the pathology reports for all the patients who underwent LSG for obesity from 2008 to 2018 in King Khalid University Hospital, Riyadh, Saudi Arabia.
Results: Of the total 1486 obese patients who underwent LSG, H. pylori was negative in 1025 patients (68.98%) and positive in 461 patients (31.02%). It was found that H. pylori positive was higher in females (53.15%) with lower BMI and was higher in males (58.82%) with higher BMI. H. pylori positive was present highly (45.16%) in the age group of more than 60 years.
Conclusions: Data analysis showed that there is a relationship between increased BMI and the incidence of H. pylori. The contradiction of our results with other studies may be related to both small sample size and diagnostic test variability. Furthermore, our study found that maybe there is a relationship between BMI and the presence of H. pylori according to gender.

Keywords: Helicobacter pylori, obese, sleeve gastrectomy

How to cite this article:
Bamehriz FY. Prevalence of Helicobacter pylori in gastric specimen following laparoscopic sleeve gastrectomy. Saudi J Laparosc 2020;5:27-32

How to cite this URL:
Bamehriz FY. Prevalence of Helicobacter pylori in gastric specimen following laparoscopic sleeve gastrectomy. Saudi J Laparosc [serial online] 2020 [cited 2020 Oct 29];5:27-32. Available from: https://www.saudijl.org/text.asp?2020/5/1/27/296783

Introduction

Helicobacter pylori is a Gram-negative bacillus (spiral bacteria);^[1] it has S-shaped appearance and motile with a tuft of 5–7 polar flagella [Figure 1].^[2] It is a microaerophilic bacterium,^[3] which is transmitted between people by oral–oral route or by fecal–oral route. Furthermore, it causes waterborne illness which occurs through contaminated water and lack of water treatment with increased risk infection with H. pylori.^[4]

Figure 1: Helicobacter pylori morphology

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H. pylori is a dominant human pathogen, and it is located in the stomach exactly within the mucous layer close to the epithelial cells [Figure 2]; it is known that it colonizes the stomach, especially the gastrointestinal mucosa for a long time without any adverse effects or symptoms.^[2],[3] The presence of H. pylori in the stomach causes gastrointestinal complications such as chronic gastritis, atrophic gastritis, gastric and duodenal peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue^[5][Figure 3].

Figure 2: Helicobacter pylori location in the stomach, especially in the mucous layer

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Figure 3: Complications caused by Helicobacter pylori infection

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Prevalence of Helicobacter pylori in Saudi Arabia and worldwide, including both obese and nonobese persons

H. pylori infection is widespread all over the world, and it has been globally estimated that 50% or more of the world population are infected.^[1]

The percentage of asymptomatic individuals in Saudi Arabia who are infected with H. pylori is 85%.^[6] In Saudi Arabia, there was only one study about the prevalence of H. pylori in obese patients who were undergoing bariatric surgery.^[7]

There were studies in the Middle East, which showed that the prevalence of H. pylori was between 44% and 49% [Figure 4].

Figure 4: Prevalence of Helicobacter pylori in Saudi Arabia and worldwide

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In other worldwide studies such as the USA, Brazil, and China, the prevalence of H. pylori in patients with digestion complications was 28.9%, 57%, and 84%, respectively.^[8],[9],[10] The differences in the prevalence of H. pylori from one region to another are due to some variant factors such as economic status, living standards, ethnicity, and geographical location.

Diagnostic Tests of Helicobacter pylori

H. pylori are diagnosed by invasive (biopsy, urease test, culture, and Gram stain) or noninvasive (serology and urea breath test [UBT]).^[11] Furthermore, both polymerase chain reaction and ELISA are serology tests used to detect immunoglobulin G antibodies in the serum of patients infected with H. pylori.^[12]

Serology is the most used method for detecting H. pylori, but its diagnostic accuracy is low (80%–84%); it is only useful for eliminating H. pyloriinfection. In fact, the positive result from serology should be confirmed by stool antigen assay (sensitivity: 94% and specificity: 92%) or UBT (sensitivity: 88%–95% and specificity 95%–100%). Ultimately, histology has an outstanding sensitivity and specificity, particularly when using it with specific immunostaining to detect H. pylori bacteria.^[13]

Methodology

We retrospectively collected the computerized data base of King Khalid University Hospital (KKUH) for all the patients who underwent laparoscopic sleeve gastrectomy (LSG) for obesity from 2008 to 2018. The data include patients' demographic, operative, and histopathology report.

We formed medical charts and tables for the data of patients, and we reviewed their pathological reports to check the presence or absence of H. pylori in their gastric specimens. Furthermore, we calculated the prevalence of H. pylori positive and negative in females and males using basic excel calculation.

Laparoscopic sleeve gastrectomy

Surgery is one of the treatments used to treat obesity such as LSG. Sleeve gastrectomy is done mainly by laparoscopic approach, using standard five trocars. It starts by dividing the greater omentum attachment to the greater curve of the stomach from the pylorus part up to the gastroesophageal junction. After the stomach is free, we apply orogastric tube size of 38 fr from the mouth and push it down to bypass the pylorus to the second part of the duodenum, and this tube is used as a caliber to the remaining part of the stomach which will stay in the patient and will be the future stomach (gastric pouch).

We start to divide the stomach from the distal part of the antrum toward the fundus of the stomach at the junction with the gastroesophageal along the 38-fr orogastric tube using surgical advanced stapling-cutting technique and machine.

The big portion of the stomach along the greater curve including the fundus part, body part, and antrum part is removed outside the body of the patient and send it to the pathology as a specimen.

In summary, 80% of the stomach is taken out, and the new stomach (gastric pouch) of the patient will have a banana-shaped stomach along the lesser curve of the stomach of a 38-fr diameter [Figure 5].

Figure 5: Laparoscopic sleeve gastrectomy surgery

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Histopathology reporting process

They take standard three area biopsies from the resected and removed part of the stomach, from fundus, body, and antrum. They applied standard and validated international preparation and microscopic features for both positive and negative findings.

Results

In total, 1486 obese patients underwent LSG in KKUH, of whom 809 were female (54.44%) and 677 were male (45.56%) [Figure 6].

Figure 6: Prevalence of females and males in age groups (10–20 years, 21–40 years, 41–60 years, and more than 60 years)

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The age range was 10–78 years, and the mean age was 33.7 years. The body mass index (BMI) range was 30–96 kg/m², and the mean BMI was 46.07 kg/m². It was found that the percentage of BMI range from 30 to 45was 55.38% of all the patients and females more than males (60.27% in females and 39.73% in males), BMI range from 46 to 60 was 37.42% and the percentage of males was higher than females (51.62% in males and 48.38% in females), and BMI more than 60 was 6.86% and was more in males than females (58.82% in males and 41.18% in females) [Figure 7].

Figure 7: Prevalence of females and males in proportion to the whole selected population

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H. pylori was negative in 1025 patients (68.98%) and positive in 461 patients (31.02%).

It was found that H. pylori positive was higher in females than males (53.15% in females and 46.85% in males).

In BMI range of 30–45, the H. pylori negative was higher than H. pylori positive (70.35% in negative H. pylori and 29.65% in positive H. pylori).

In BMI range of 46–60, the H. pylori positive was less than H. pylori negative (32.73% in positive and 67.27% in negative).

In BMI range of >60, the H. pylori negative was higher (66.67% in negative and 33.33% in positive) [Figure 8], [Figure 9], [Figure 10].

Figure 8: Prevalence of females and males in body mass index categories (30–45, 46–60, and more than 60)

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Figure 9: Prevalence of Helicobacter pylori positive and negative in body mass index categories (30–45, 46–60, and more than 60)

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Figure 10: Prevalence of Helicobacter pylori positive and negative in females and males

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Discussion

Age

It was found that H. pylori was present highly 45.16% in the age group of more than 60 years, 38.31% in the age group of 41–60 years, 28.79% in the age group of 21–40 years, and 25.71% in the age group of 10–20 years. Our study confirmed that what was in other studies, it was found that there is a relationship between the H. pylori rates with an increase in age.^[14],[15] However, Akeel et al.^[12] showed that the rate of H. pylori is decreasing with an increase in age.

Gender

Our result indicated that the presence of H. pylori was in females more than males (53.15% in females and 46.85% in males). Akeel et al.^[12] showed in their study that there was no big difference in the prevalence of H. pylori positive between males and females. In other studies, the authors stated that the prevalence of H. pylori was higher in females,^[14] which agrees with our results. However, other studies reported that the rate of H. pylori positive was more in males than females.^[16],[17] Zamani et al.^[18] conducted in their recent meta-analysis study that implicated 183 studies from 73 countries and revealed that males were prevalent of H. pylori across the world, but none of these differences between males and females approached statistical significance.

Body mass index

In our study, the prevalence of BMI 30–40 range was the highest (55.38%).

In term of gender, the BMI category from 30 to 45 was higher in females than males (60.27% in females and 39.73% in males), in BMI 46–60 the prevalence of males was more than females (51.62% in males and 48.38% in females), and BMI more than 60 the prevalence was high in males (58.82%).

Al-Hazzaa et al.^[19] study was done from 2009 to 2010, which showed that the prevalence of obesity in males was higher than females. El Mouzan et al.^[20] showed in their national study that obesity in males was higher than females, but there was no significant difference between them (11.2% in males and 10% in females).

Collison et al.^[21] in their study in Riyadh conducted that the prevalence of obesity in males was higher (57.9%).

Body mass index and Helicobacter pylori

In contrast to other studies, our study showed that the prevalence of H. pylori positive was higher in BMI of more than 60 (33.33%), 32.73% in BMI 46–60 category, and 29.65% in BMI 30–45 category. We conducted in our study that when the BMI decreases the H. pylori decrease, there is a correlation between them. In another study, their result showed that there was no big difference in the prevalence of H. pylori positive between different BMI categories.^[12] Lender et al.^[22] reported in their recent study that the H. pylori prevalence and the rates of obesity have an inverse correlation between them. Although, other studies proved there was a positive correlation between H. pylori and obesity rates.^[23] There are some other studies that showed the prevalence of H. pylori among obese patients who underwent bariatric surgery such as Al-Akwaa^[7] study showed that the H. pylori prevalence was very high in obese patients (85.5% from 62 patients). Vanek et al.^[24] study showed the low prevalence of H. pylori among obese patients (11% from 96 patients). Furthermore, there were studies that failed to show if there was any relationship between H. pylori infection and BMI, with 18 observational studies included 10,000 samples, showed that H. pylori-positive patients had higher BMI.^[25]

Body mass index, Helicobacter pylori, and gender

Our study results showed that the prevalence of H. pylori positive in BMI 30–45 category according to gender was higher in females (58.20%).

In 46–60 BMI category, the prevalence of H. pylori positive in males was more than females, but there was no significant difference between them (50.55% in males and 49.45% in females).

In BMI of more than 60, the prevalence of H. pylori positive was higher in males than females (61.76% in males and 38.24% in females), and there was a significant difference between them. According to our results, we expect that there is no relationship between the presence of H. pylori and BMI according to gender. Although, when the BMI increases the H. pylori prevails in males decreases in females.

Conclusion

Data analysis showed that there is a relationship between increased BMI and the incidence of H. pylori. The contradiction of our results with other studies may be related to both small sample size and diagnostic test variability. Furthermore, our study found that maybe there is a relationship between BMI and the presence of H. pylori according to gender.

Acknowledgment

Thanks to Sarah Bamehriz, 4^th-year student, in the College of Applied Medical Sciences at King Saud University for her major contribution in data collecting and writing Thanks to the College of Medicine at King Saud University for their support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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