Endocrine Abstracts

Background: Studies of morbid obese patients undergoing bariatric surgery (BS) have revealed that obesity is related with an increased prevalence of endoscopic and histologic gastritis. Performing esophagogastroduodenoscopy (EGD) prior to BS allows the detection and treatment of Helicobacter pylori (H.pylori) infection which is considered to be limiting access to bariatric surgery.

Aim: The aim of this study was to determine the prevalence of gastric lesions and Helicobacter pylori (Hp) infection in a group of morbidly obese patients referred for endoscopy prior to bariatric surgery.

Methods: This is a monocentric prospective descriptive study including 40 morbidly obese patients undergoing EGD before BS. Preoperative data included Age, gender, BMI, comorbidities, upper digestive symptoms, EGD findings and H.pylori infection assessed during a histopathological examination.

Results: EGD was performed in 40 patients. Only 30 patients underwent bariatric surgery:79.3% had sleeve gastrectomy and 21.4% had bypass surgery. The mean age was 39.49 ± 8.41 years, 35(85.7%) were females, with a mean body mass index of 48.39 ±7.03 kg/m². Of the study population,42.9% had hypertension, 20% had type 2 diabetes, 28.6% had dyslipidemia, 8.6% had hypothyroisidm, 65.7% had obstructive sleep apnea syndrome, 14.3% had hypochromic microcytic anemia and 28.6% had vitamin D deficiency. The overall upper digestive symptoms prevalence was 48.5%, with the most frequent being gastroesophageal reflux disease (37.1%), followed by constipation (11.4%). Regarding endoscopic findings, 45.5% presented no endoscopic lesions. Pathological findings were detected in 61.11% of asymptomatic patients. Of the study population, 35.5% presented hyperemic gastropathy, 18.5% erosive gastropathy, 15.6% had hiatus hernia, 21.9% had peptic oesophagitis and 16.1% had cardial beance. No patient had duodenal or gastric ulcer. On histopathological examination, 40.7% presented no lesions, 59.3% (n=24) had chronic non atrophic gastritis and no patient had intestinal metaplasia or dysplasia. H.pylori was present in 20 (50%) patients. All patients with H. pylori infection had chronic gastritis of variable severity. There was no significant association between H.pylori infection and age (P=0.8), gender (P=0.6), BMI (P=0.38), hypochromic microcytic anemia (P=0.1), vitamin D deficiency (P=0.67).

Conclusion: EGD with histological analysis plays an important role in the pre-surgical evaluation in BS, with a high rate of pathological findings in asymptomatic patients.