PRE-OPERATIVE SCREENING OF <i>HELICOBACTER PYLORI</i> IN BARIATRIC PATIENTS: IS HISTOPATHOLOGICAL ANALYSIS NECESSARY?

VALADARES, Erick Coelho; GESTIC, Martinho Antonio; UTRINI, Murillo Pimentel; CHAIM, Felipe David Mendonça; CHAIM, Elinton Adami; CAZZO, Everton

doi:10.1590/S0004-2803.202202000-49

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ORIGINAL ARTICLE • Arq. Gastroenterol. 59 (2) • Apr-Jun 2022 • https://doi.org/10.1590/S0004-2803.202202000-49 copy

PRE-OPERATIVE SCREENING OF HELICOBACTER PYLORI IN BARIATRIC PATIENTS: IS HISTOPATHOLOGICAL ANALYSIS NECESSARY?

Pesquisa pré-operatória de infecção por Helicobater pylori em pacientes bariátricos: a análise histopatológica é necessária?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Helicobacter pylori infection has been reported to lead to post-operative complications after bariatric surgery (BS), especially marginal ulcers. The optimal method for pre-operative screening is yet to be determined.

Objective:

To analyze the diagnostic accuracy of the endoscopic urease test for the detection of H. pylori in individuals undergoing BS and the main endoscopic and histological changes within this population.

Methods:

A cross-sectional study was carried out based on a database from medical records of 232 individuals who underwent BS between 2016 and 2019 at a tertiary university hospital. Clinical, anthropometric, and endoscopic data were analyzed. The gold-standard method considered to calculate diagnostic accuracy variables was histopathological examination through hematoxylin-eosin/Giemsa stains.

Results:

87.5% of the participants were female; mean age was 38.5±9.5 years and average body mass index was 37.6±3.8 kg/m². The commonest endoscopic finding was gastritis (50.9%) with a predominance of the mild erosive form (25%). Upon histological examination, 59.1% of the participants had confirmed H. pylori infection. H. pylori infection was associated with higher frequencies of endoscopic duodenitis (23.4% vs 12.6%; P=0.04), histological chronic gastritis (100% vs 56.8%; P<0.0001) and histological acute gastritis (58.4% vs 2.1%; P<0.0001). The urease test had a sensitivity of 79.6% and a specificity of 97.9%, leading to an overall accuracy of 87.1%.

Conclusion

The endoscopic urease test is highly accurate for pre-operative screening of H. pylori infection in individuals who undergo BS. H. pylori infection was significantly associated with endoscopic (duodenitis) and histopathological (chronic and active gastritis) changes.

Keywords:
Obesity; bariatric surgery; Helicobacter pylori; biopsy; urease

Endoscopic Findings	N (%)	Classification		N (%)

Gastritis	118 (50.9%)	Non-erosive
		Mild		25 (10.7%)
		Moderate		9 (3.8%)
		Severe		0

		Erosive
		Mild		60 (25%)
		Moderate		21 (9%)
		Severe		3 (1.2%)

Duodenitis	45 (19.4%)	Non-erosive
		Mild		7 (3%)
		Moderate		2 (0.8%)
		Severe		0

		Erosive
		Mild		25 (10.7%)
		Moderate		9 (3.8%)
		Severe		2 (0.8%)

Esophagitis	38 (16.4%)	Non-erosive		0
		Erosive grade A		27 (11.6%)
		Erosive grade B		9 (3.8%)
		Erosive grade C		2 (0.8%)
		Erosive grade D		0

Hiatal Hernia		< 3 cm		3 (1.2%)
	5 (2.2%)	≥ 3 cm		2 (0.8%)

			Sakita classification
			A1	0
			A2	1 (0.4%)
Peptic Ulcer	9 (3.9%)	Gastric	H1	1 (0.4%)
			H2	2 (0.8%)
			S1	3 (1.2%)
			S2	0

			A1	0
			A2	0
		Duodenal	H1	0
			H2	1 (0.4%)
			S1	1 (0.4%)
			S2	0

Polyps	22 (9.5%)	Gastric		21 (9%)
		Duodenal		1 (0.4%)

	*No H. pylori* infection**	H. pylori infection	Value of P
N	95 (40.9%)	137 (59.1%)	NA
Age (years)	37.6±9	39.1±9.9	0.2
Gender	F: 79 (83.2%)	F:124 (90.5%)	0.1
	M: 16 (16.8%)	M: 13 (9.5%)
BMI (kg/m²)	37.6±4.7	36.8±6	0.3
Comorbidities
Hypertension	38 (40%)	59 (43.1%)	0.6
Type 2 diabetes	13 (13.7%)	25 (18.2%)	0.3
Dyslipidemias	12 (12.6%)	30 (21.9%)	0.07
Endoscopic findings
Erosive esophagitis	22 (23.2%)	16 (11.7%)	0.02
Gastritis (overall)	41 (43.2%)	77 (56.2%)	0.05
Non-erosive gastrites	13 (13.7%)	21 (15.3%)	0.7
Erosive gastritis	28 (29.5%)	56 (40.9%)	0.08
Duodenitis (overall)	12 (12.6%)	32 (23.4%)	0.04
Non-erosive duodenitis	1 (1%)	8 (5.8%)	0.07
Erosive Duodenitis	11 (11.6%)	24 (17.5%)	0.2
Gastric Ulcer	3 (3.2%)	4 (2.9%)	0.9
Duodenal Ulcer	1 (1%)	1 (0.7%)	0.8
Atrophic Gastritis	4 (4.2%)	5 (3.6%)	0.8
Hiatal Hernia	2 (2.1%)	3 (2.2%)	0.6
Gastric polyps	15 (15.8%)	6 (4.4%)	0.002
Histopathological findings
Chronic gastritis	54 (56.8%)	137 (100%)	<0.0001
Active gastritis	2 (2.1%)	80 (58.4%)	<0.0001
Glandular atrophy	13 (13.7%)	23 (16.8%)	0.5
Intestinal metaplasia	3 (3.2%)	5 (3.6%)	0.8
Chronic duodenitis	1 (1%)	3 (2.2%)	0.5

Variable	Value	95% Confidence interval
Sensitivity	79.6%	71.8%-86%
Specificity	97.9%	92.6%-99.7%
Positive likelihood ratio	37.8	9.6-149.3
Negative likelihood ratio	0.2	0.2-0.3
Positive predictive value	98.2%	93.2%-99.5%
Negative predictive value	76.9%	70. 5%-82.2%
Overall accuracy	87.1%	82.1%-91.1%

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] Corresponding author: Everton Cazzo. E-mail: notrevezzo@yahoo.com.br