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Rudasill J, Peeler C, Grant D, Lazar C, Criswell SL. A comparison of staining methods for Helicobacter pylori in laparoscopic vertical sleeve gastrectomy resections. Lab Med 2024; 55:386-390. [PMID: 38048075 DOI: 10.1093/labmed/lmad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Helicobacter pylori is an important public health concern due to its status as a carcinogenic bacterium. Well adapted to the acidic environment of the human stomach, the variety of strains and virulence factors of the organism when interacting with the host immune system creates an individualistic response. Although estimates suggest that approximately half of the global population is infected with H pylori, the majority of infected persons remain asymptomatic while harboring an increased risk of intestinal metaplasia and gastric cancers. Therefore, appropriate diagnostic testing protocols are imperative. METHODS This study compared labeling methodologies, including Wright stain, alcian yellow toluidine blue (AYTB), and immunohistochemistry (IHC) on formalin-fixed paraffin-embedded stomach resections from sleeve gastrectomy patients, to detect H pylori infection. RESULTS Although all 3 labeling methods evidenced similar specificity in H pylori detection, the IHC method was significantly more sensitive. However, the IHC cost per test was approximately 5-fold higher than that of the Wright or AYTB stains, and the technical time required per test was at least 6-fold that of Wright or AYTB. CONCLUSION Despite the higher cost per test, IHC is the most sensitive and preferred method for determination of H pylori infection.
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Affiliation(s)
- JoAnna Rudasill
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Chelsea Peeler
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Danielle Grant
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Cynthia Lazar
- Department of Pathology, Methodist University Hospital, Memphis, TN, US
| | - Sheila L Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
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Grant D, Peeler C, Rudasill J, Lazar C, Bodkin A, Criswell SL. The presence of H. pylori in laparoscopic sleeve gastrectomy specimens is associated with increased mucosal thickness, presence of secondary follicles, increased chronic inflammation, and intestinal metaplasia. J Histotechnol 2024; 47:5-12. [PMID: 37823587 DOI: 10.1080/01478885.2023.2265601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Helicobacter pylori is putatively present in over half of the global human population and is recognized as a carcinogenic agent that increases the likelihood of infected patients developing gastric adenocarcinoma or gastric lymphoma. Although there are several means for testing for H. pylori, the gold standard remains the invasive histologic evaluation. The current most popular form of bariatric surgery is the laparoscopic sleeve gastrectomy (LSG) and is the only bariatric surgery which supplies a specimen for histologic evaluation. While non-invasive testing is effective in diagnosing and monitoring H. pylori infection, histological examination of biopsies and resections is the only way to grade chronic inflammation and evaluate specimens for additional pathologies such as intestinal metaplasia. The investigators evaluated 203 sequential LSG specimens collected from a major metropolitan hospital over the period of one year. Specimens were processed to paraffin, stained with hematoxylin and eosin, alcian blue, and immunohistochemistry to determine the presence of H. pylori, chronic inflammation, presence of secondary lymphoid follicles in the mucosa, mucosal thickness, and presence of intestinal metaplasia. Statistical analyses demonstrated a significant positive correlation among all factors examined. The overall positivity rate of H. pylori in LSG specimens was 18.2% but ranged from 6.9-23.8% depending on whether the treating clinician performed routine pre-surgical endoscopy. The presence of H. pylori was associated with a higher average chronic inflammation grade, intestinal metaplasia, thicker mucosa, and presence of lymphoid follicles with germinal centers in the mucosa.
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Affiliation(s)
- Danielle Grant
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chelsea Peeler
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - JoAnna Rudasill
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cynthia Lazar
- Department of Pathology, Methodist University Hospital, Memphis, TN, USA
| | - Amanda Bodkin
- Department of Pathology, Methodist Le Bonheur Germantown Hospital, Germantown, TN, USA
| | - Sheila L Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
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El Nakeeb A, Salem A, El Sorogy M, Elrefai M, Rashad AE, Sewefy AM, Kayed T, Mohammed MM, Zaid A, Aldossary HM, Dabobash MD, Sboui K, Attia M. Impact of Helicobacter pylori Status on Postoperative Morbidities After Laparoscopic Sleeve Gastrectomy in an Endemic Region (a Retrospective Multicentric Study). Obes Surg 2024; 34:183-191. [PMID: 37989926 DOI: 10.1007/s11695-023-06961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Studies are still ongoing to determine whether Helicobacter pylori (HP) may affect the results of laparoscopic sleeve gastrectomy (LSG). The main research objectives were HP prevalence in patients with severe obesity and the effects of HP status on outcomes. PATIENTS AND METHODS This multicenter retrospective study included patients with severe obesity who had LSG. The patients were grouped into three groups based on the HP status of preoperative endoscopic biopsies and postoperative specimen results: group I (negative HP), group II (eradicated HP), and group III (positive HP). The primary outcome was the overall postoperative morbidities. RESULTS One thousand six hundred fifteen patients who underwent LSG for severe obesity were included in this study. Seven hundred fifty (46.4%) patients had negative HP, and 637 (39.4%) patients had eradicated HP, whereas 228 (14.1%) patients had positive HP. The antral and gastric body wall thickness was significantly noticed with positive HP. The groups had no significant differences regarding postoperative complication frequency, severity, and hospital mortality. The rates of gastric leakage in the three groups do not differ significantly. BMI > 50, gastropexy, gastric thickness, and antral resection were found to be independent risk factors for the occurrence of postoperative complications after LSG. There was no statistical significance as regards postoperative %TWL and %EWL among the three groups. CONCLUSION The early results of LSG do not appear to be impacted by HP's status. The early postoperative course is unaffected by HP eradication anymore. Therefore, routine preoperative HP testing may not be as necessary, and management can be finished after LSG.
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Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt.
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia.
| | - Ali Salem
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed El Sorogy
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Mohamad Elrefai
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Aly E Rashad
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | | | - Taha Kayed
- Minia University Hospital, Minya, 61519, Egypt
| | | | - Ahmed Zaid
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | | | - Mahmoud D Dabobash
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | - Kalthoum Sboui
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | - Mohamed Attia
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
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Zhao CN, Xiao LL, Zhang Y. Effects of Helicobacter pylori Infection on the Prognosis of Chronic Atrophic Gastritis by Inducing the Macrophage Polarization. Gastroenterology Res 2023; 16:226-233. [PMID: 37691749 PMCID: PMC10482605 DOI: 10.14740/gr1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023] Open
Abstract
Background Recently, the effects of Helicobacter pylori (H. pylori) infection on the prognosis of chronic atrophic gastritis (CAG) are still unclear. The aim of our study was to discuss the role of H. pylori infection on the prognosis of CAG by inducing the M1/M2 macrophage polarization. Methods A total of 180 subjects as control (group 1), CAG patients without H. pylori infection (group 2) and H. pylori-associated CAG patients (group 3) were respectively recruited for this cross-sectional investigation in Daqing Oilfield General Hospital from May 2019 to July 2020. Their serum samples were collected to determine the concentrations of pro-inflammatory and anti-inflammatory cytokines. Meanwhile, the gastric mucosa was excised to determine the related gene expressions on the M1/M2 macrophage polarization. Then the prognosis of CAG was evaluated according to the status of clinical manifestations and endoscopic examination after the follow-up. Results Notably, it was proved that compared with the control group, the expressions and concentrations of pro-inflammatory cytokines (M1 macrophage: inducible nitric oxide synthase (iNOS), tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin-6 (IL-6)) were significantly higher, while the anti-inflammatory cytokines (M2 macrophage: arginase-1 (Arg-1), IL-4 and IL-10) were apparently reduced in the group 2 and group 3 (P < 0.05). Moreover, more days were needed for the prognosis of CAG in group 3 than those in group 2, which was accompanied by higher expressions of pro-inflammatory and lower anti-inflammatory cytokines at the baseline (P < 0.05). Furthermore, negative correlations were shown between the concentrations of iNOS, TNF-α, IFN-γ and IL-6, and the prognosis of CAG (P < 0.05), while positive correlations were observed between the contents of IL-4 and IL-10, and prognosis of CAG (P < 0.05). Conclusion These above results indicated that H. pylori infection-induced disorders of M1/M2 macrophage polarization could affect the prognosis of CAG.
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Affiliation(s)
- Chun Na Zhao
- Department of Gastroenterology, Daqing Oilfield General Hospital, Daqing City, Heilongjiang Province, 163000, China
- These authors contributed equally to this manuscript
| | - Li Li Xiao
- Department of Gastroenterology, Daqing Oilfield General Hospital, Daqing City, Heilongjiang Province, 163000, China
- These authors contributed equally to this manuscript
| | - Ying Zhang
- Department of Gastroenterology, Daqing Oilfield General Hospital, Daqing City, Heilongjiang Province, 163000, China
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Alqahtani AR. Response. Gastrointest Endosc 2022; 96:1090. [PMID: 36404089 DOI: 10.1016/j.gie.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022]
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Is Molecular Analysis Mandatory for Better Post-surgical Outcome in Sleeve Gastrectomy Specimens with Asymptomatic Helicobacter pylori Colonization? A Study from Pakistan. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-122528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Helicobacter pylori colonizes gastric tissue in obese patients and mostly remains undetected clinically, as histological and molecular analysis is seldom ordered in such cases. Objectives: This study aimed to detect the frequency of H. pylori using different techniques in sleeve gastrectomy specimens of obese patients with minimal or no symptoms suggestive of gastritis. Methods: This longitudinal study was carried out at Farooq Hospital Westwood Lahore, Morbid Anatomy and Histopathology Department and Resource Laboratory at the University of Health Sciences, Lahore, Pakistan, from February 2021 to September 2021. This study selected 80 cases who underwent sleeve gastrectomy within six months. Helicobacter pylori was detected by rapid urease test (RUT), modified Giemsa staining, and polymerase chain reaction (PCR) techniques. Results: Most patients (83.7%) were clinically asymptomatic, while 10% had mild and 6.3% had moderate to severe gastritis symptoms. Of the asymptomatic patients, 56.7% of biopsies showed chronic gastritis. Rapid urease test and modified Giemsa staining showed positive evidence for H. pylori in 47.3% of cases, whereas an additional 13.2% of biopsies that were negative on conventional methods showed the amplification of H. pylori DNA by PCR. Patients were discharged with proton-pump inhibitors therapy (40 mg/day) that showed no adverse post-surgical event over a follow-up of six months. Conclusions: Persistent obesity and other socioeconomic factors may lead to colonizing asymptomatic H. pylori infection. More sensitive techniques for detecting H. pylori may be employed in resource-constrained settings for better patient outcomes and to minimize the complications after sleeve gastrectomy.
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Ergin A, Çiyiltepe H, Karip AB, Fersahoğlu MM, Bulut NE, Çakmak A, Topaloğlu B, Bilgili AC, Somay A, Taşdelen İ, Akyüz Ü, Memişoğlu K. The Effect of Helicobacter pylori Eradication on Gastric Wall Thickness in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 31:4024-4032. [PMID: 34075550 DOI: 10.1007/s11695-021-05513-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The most important cause affecting the thickness of the gastric wall other than the tumor is chronic gastritis caused by Helicobacter pylori (Hp), which is most frequently detected in the antrum. This study aims to investigate the effect of bismuth-based treatment (BBT) combined with proton pump inhibitor (PPI) on wall thicknesses measured in the postoperative gastric specimen and early postoperative complications in patients with Hp-positive pre-LSG endoscopic gastric biopsies. MATERIALS AND METHODS The patients who underwent LSG procedure for morbid obesity were divided into three groups as follows: Hp-negative, Hp-positive without eradication treatment, and Hp-positive, and LSG was performed after eradication treatment. Macroscopic and microscopic gastric wall thickness measurements were made at a distance of 1 cm from the proximal surgical margin, from the middle part of the specimen, and 1 cm from the distal surgical margin in the gastric specimen and the results were compared. RESULTS A total of 132 patients were included in the study, 44 patients in each group. Microscopically measured antrum mucosal thickness was found to be statistically significantly higher in group 2 compared to other groups (groups 1.15, 1.35, 1.16 mm, respectively, p = 0.000). There was no difference between the groups in terms of early complications such as bleeding, wound site infection, or leakage from the staple line within the first 28 days after surgery. CONCLUSION This study found that LSG had no effect on early complications due to Hp positivity or eradication of Hp. KEY POINTS • The presence of HP increases the wall thickness of the gastric antrum mucosa. • After HP eradication, stomach antrum wall thickness returns to normal. • HP eradication before LSG reduces the wall thickness of the gastric antrum mucosa. • It was determined that HP scanning and eradication before LSG had no effect on postoperative complications.
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Affiliation(s)
- Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey.
| | - Hüseyin Çiyiltepe
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Aziz Bora Karip
- General Surgery Department, Istanbul Oncology Hospital, Cevizli Mah. Toros Street No:86 Maltepe, Istanbul, Turkey
| | - Mehmet Mahir Fersahoğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Ahmet Çakmak
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Berk Topaloğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Ali Cihan Bilgili
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Adnan Somay
- Pathology Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - İksan Taşdelen
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Ümit Akyüz
- Gastroenterology Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Kemal Memişoğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
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Farsimadan M, Heravi FS, Emamvirdizadeh A, Moradi S, Iranpour H, Tabasi E, Eskandarion MR, Azizian R, Tabasi M. Evaluation of Helicobacter pylori Genotypes in Obese Patients with Gastric Ulcer, Duodenal Ulcer, and Gastric Cancer: An Observational Study. Dig Dis 2021; 40:355-361. [PMID: 34010829 DOI: 10.1159/000517262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Obesity is a well-known risk factor for a variety of gastrointestinal disorders (GID). Helicobacter pylori is associated with different GID, such as gastric cancer and chronic gastritis. In this study, we investigated the prevalence of dominant genotypes in H. pylori isolated from obese patients diagnosed with gastric ulcer, duodenal ulcer, and gastric cancer. METHODS A total of 222 H. pylori-positive samples were collected from patients with obesity. GID and gastric cancer were identified by endoscopy and histopathology, respectively. Three biopsy specimens from the gastric antrum were obtained from each patient for culture tests, histological examination, and identification of vacuolating cytotoxin A (vacA) (vacA s1, vacA s2, vacA m1, vacA m2, vacA s1m1 vacA s1m2, vacA s2m1, and vacA s2m2), cagA, cagE, iceA1, oipA, dupA, and babA2 using polymerase chain reaction. RESULTS vacA, cagE, cagA, iceA1, oipA, dupA, and babA2 genes were detected in 222 (100%), 171 (77%), 161 (72.5%), 77 (34.6%), 77 (34.6%), 137 (61%), and 69 (31%) patients with obesity, respectively. Our findings revealed that vacA, iceA1, oipA, and babA2 were significantly associated with a higher risk of GID, while cagE, cagA, and dupA indicated no correlation with the development of GID. Also, in the combination of s- and m-region genotypes, s1m2 (79%) was the most frequently identified genotype in patients with obesity. A significant association was also found between cagA and the presence of vacA genotypes (except for vacA m1 and babA2). CONCLUSIONS This study indicated the high prevalence of different virulence genes in H. pylori isolated from obese patients and supported the significant role of H. pylori in the development of GID.
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Affiliation(s)
- Marziye Farsimadan
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | | | - Alireza Emamvirdizadeh
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Samaneh Moradi
- Department of Biology, Shahrood Branch, Islamic Azad University, Shahrood, Iran
| | - Hamidreza Iranpour
- Laboratory of Regenerative Medicine & Biomedical Innovations, Pasteur Institute of Iran, Tehran, Iran.,Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran
| | - Ehsan Tabasi
- Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Reza Eskandarion
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.,Cancer Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Azizian
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Tabasi
- Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran.,Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Turan G, Kocaöz S. Helicobacter Pylori Infection Prevalence and Histopathologic Findings in Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 29:3674-3679. [PMID: 31290105 DOI: 10.1007/s11695-019-04052-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) is a type of bacteria that affects more than half of the world's population and has been associated with gastritis. The relationship between H. pylori and obesity is controversial. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used surgery for morbidly obese patients. The aim of this study was to investigate the rate of H. pylori in patients undergoing LSG. METHODS Biopsy specimens of 32,743 patients who underwent esophagogastroduodenoscopy (EGD) and resection materials from 1257 patients who underwent LSG were examined histopathologically. The relationships between body mass index (BMI), age, gender, H. pylori infection, and intestinal metaplasia (IM) were investigated in patients with gastritis. RESULTS In patients undergoing EGD, the association of H. pylori infection was found to be increased in males and the elderly (p < 0.001). The presence of gastritis and IM was significantly higher with H. pylori infection (p < 0.001 and p = 0.001, respectively). H. pylori infection was significantly higher in patients over the age of 41 years (p < 0.001). There was no significant difference between the results of H. pylori before and after LSG surgery (p = 0.923). The presence of H. pylori together with gastritis and IM was found to be significant (p < 0.001). CONCLUSIONS H. pylori infection increases with age. No significant difference was found in the examination for H. pylori before and after LSG surgery. In addition, no relationship was found between H. pylori and excess weight. However, due to the low average age of patients who underwent LSG, further studies are needed in this area.
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Affiliation(s)
- Gülay Turan
- The Department of Medical Pathology, Faculty of Medicine, Balıkesir University, Çağış Yerleşkesi.10145 Bigadiç yolu üzeri 17 km, Balıkesir, Turkey
| | - Servet Kocaöz
- Department of General Surgery, Ankara Atatürk Eğitim ve Araştırma Hastanesi Üniversiteler mah, Bilkent cad., No:1, 06800 Çankaya, Ankara, Turkey.
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Serin KR, Akyüz Ü, Batman B, Uymaz DS, Altun H. Does Helicobacter pylori infection influence the major postoperative complication rate after sleeve gastrectomy? A retrospective cohort study in an endemic region. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 29:379-383. [PMID: 30249550 DOI: 10.5152/tjg.2018.17373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIMS Helicobacter pylori infection is very common in Eastern countries. Little is known about the impact this infection has on bariatric surgery outcomes. This retrospective cohort study conducted on obese Turkish adults who underwent sleeve gastrectomy at a single center aimed to determine the prevalence of H. pylori infection and the effect of this infection on the rate of early major postoperative complications. MATERIALS AND METHODS All consecutive patients who underwent sleeve gastrectomy for obesity between 2014 and 2015 and who had complete data were enrolled. A single surgeon performed all procedures. All resected specimens were sent to pathology for analysis. RESULTS Of the 460 patients who met the eligibility criteria, 326 (71%) were female. The average (±standard deviation) age and body mass index were 37.5±10.0 years and 42.7±7.7 kg/m2, respectively. Histology revealed that 150 (33%) patients had H. pylori infection. The H. pylori-infected group developed two complications (leakage and intra-abdominal collection). The uninfected group developed three complications (all bleeding related). The two groups did not differ significantly regarding postoperative complication rates (1.3% vs. 1.0%; p=0.717). CONCLUSION H. pylori infection did not affect the rate of early complications after sleeve gastrectomy. This suggests that H. pylori screening or eradication policy is not essential for asymptomatic candidates who have undergone sleeve gastrectomy.
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Affiliation(s)
| | - Ümit Akyüz
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Center, İstanbul, Turkey
| | - Burçin Batman
- Department of General Surgery, Ulus Liv Hospital, İstanbul, Turkey
| | | | - Hasan Altun
- Department of General Surgery, Ulus Liv Hospital, İstanbul, Turkey
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Is Routine Preoperative Esophagogastroduodenoscopy Screening Necessary Prior to Laparoscopic Sleeve Gastrectomy? Review of 1555 Cases and Comparison with Current Literature. Obes Surg 2018; 28:52-60. [PMID: 28685362 DOI: 10.1007/s11695-017-2813-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Controversy exists as to whether routine preoperative esophagogastroduodenoscopy (p-OGD) in bariatric surgery should be routinely undertaken or undertaken selectively based on patients' symptoms. As very few studies have focused on the role of p-OGD prior to the increasingly common laparoscopic sleeve gastrectomy (LSG), we assessed the role/impact of p-OGD in LSG patients. METHODS Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (2011-2014, n = 1555). All patients were screened by p-OGD. Patient characteristics were analyzed, and p-OGD findings were categorized into four groups employing Sharaf et al.'s classification (Obes Surg 14:1367-1372, 23). We assessed the impact of p-OGD findings on any change in surgical management or lack thereof. RESULTS p-OGD findings indicated that 89.5% of our patients had normal or mild findings and were asymptomatic (groups 0 and 1, not necessitating any change in surgical management), and no patients had gastric cancer or varices (group 3). A total of 10.5% of our sample were categorized as group 2 patients who, according to Sharaf et al. (Obes Surg 14:1367-1372, 23), might have their surgical approach changed. All patients diagnosed preoperatively with hiatal hernia (HH) had LSG with crural repair and their symptoms resolved postoperatively. CONCLUSION Due to effectiveness and best utilization of resources, routine p-OGD screening in patients scheduled for LSG may require further justification for asymptomatic patients especially in regions with low upper GI cancers. p-OGD findings had low impact on the management of asymptomatic patients. Crural repair plus LSG was effective for hiatal hernia.
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12
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Reply to the Letter to the Editor on "Helicobacter Pylori Does Not Affect Postoperative Outcomes after Sleeve Gastrectomy". Obes Surg 2017; 27:2466. [PMID: 28660598 DOI: 10.1007/s11695-017-2786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Hansen SK, Pottorf BJ, Hollis HW, Rogers JL, Husain FA. Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy? Am J Surg 2017; 214:1151-1155. [PMID: 28705420 DOI: 10.1016/j.amjsurg.2017.06.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/31/2017] [Accepted: 06/13/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study attempts to determine if enough pathological abnormalities in gastric remnants from sleeve gastrectomy exist to warrant full pathologic evaluation in all remnants. METHODS Data was collected on patients undergoing sleeve gastrectomy between 08/01/2011 and 06/30/2014. Significant abnormalities were classified as any pathology that might require follow-up or treatment beyond standard follow-up. Age, comorbidities, gender, and Helicobacter pylori titers were analyzed and compared with pathology specimens using 95% confidence intervals and Phi contingency coefficients. RESULTS Full pathologic evaluation was available for 351/387 patients (91.2%). No examples of malignancy or dysplasia were identified. Gastritis was the most common abnormality. There was a statistically significant association between preoperative H. pylori and significantly abnormal pathology (p = 0.003). Other comorbidities had no association. CONCLUSIONS These results suggest that full pathologic evaluation of the gastric remnant following sleeve gastrectomy is unnecessary, particularly when gross pathology is not noted at initial operation.
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Affiliation(s)
- S K Hansen
- Department of Graduate Medical Education, General Surgery, Saint Joseph Hospital, Denver, CO, USA.
| | - B J Pottorf
- Department of Surgery, Longmont United Hospital, Centura Health Physicians Group, Longmont, CO, USA
| | - H W Hollis
- Department of Graduate Medical Education, General Surgery, Saint Joseph Hospital, Denver, CO, USA
| | - J L Rogers
- Summit Analytical Biostatistics, Denver, CO, USA
| | - F A Husain
- Department of Surgery, Bariatric Services, Oregon Health and Sciences University, Portland, OR, USA
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14
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Helicobacter pylori Does not Affect Postoperative Outcomes After Sleeve Gastrectomy. Obes Surg 2016; 27:1298-1301. [DOI: 10.1007/s11695-016-2470-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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AbdullGaffar B, Raman L, Khamas A, AlBadri F. Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens? Obes Surg 2016; 26:105-10. [PMID: 25986428 DOI: 10.1007/s11695-015-1726-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure to reduce weight in morbidly obese patients, with an overall low rate of complications and thus gaining a worldwide popularity. It provides an opportunity to study the pathology of the stomach in obese patients. Most studies, however, focused on clinical aspects, surgical techniques, and postoperative complications. Few authors studied the histopathologic findings. Whether routine histopathologic examination is warranted in patients with grossly unremarkable LSG specimens and nonsignificant clinical history was not previously studied. METHODS We conducted a prospective study over 8 years to compare the prevalence, the morphologic spectrum and importance of histopathologic findings, and the frequency of incidental neoplasms in LSG specimens with other studies. We also proposed a protocol for the gross handling and sectioning of LSG specimens. RESULTS We found 546 LSG specimens. Five patients developed iatrogenic postoperative complications, two of which pursued a medicolegal case. There was no association between the histopathologic findings and the complications. Less than 1 % of incidental benign lesions were found. No malignancies were identified. All of the patients without postoperative complications had uneventful outcome after 5 months to 6 years follow-up. CONCLUSIONS Routine microscopic examination of all LSG specimens is not necessary. Selective microscopic examination guided by relevant clinical history and macroscopic examination is a better option. This protocol will save money, time, and workload without compromising patient's safety and future management. However, a careful gross description is still necessary in certain cases for potential future medicolegal implications.
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Affiliation(s)
- Badr AbdullGaffar
- Pathology Section, Rashid Hospital, Oud Metha Road, Dubai, United Arab Emirates.
| | - Lakshmiah Raman
- Histopathology Unit, Dubai Hospital, Dubai, United Arab Emirates
| | - Ali Khamas
- Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Faisal AlBadri
- Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates
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16
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Brownlee AR, Bromberg E, Roslin MS. Outcomes in Patients with Helicobacter pylori Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2016; 25:2276-9. [PMID: 26001881 DOI: 10.1007/s11695-015-1687-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In vertical sleeve gastrectomy (VSG), the majority of the stomach is resected and much of the tissue colonized with Helicobacter pylori and the bulk of acid producing cells are removed. In addition, the effect of H. pylori colonization of the stomach of patients undergoing stapling procedures is unclear. As a result, the need for detection and treatment of H. pylori in patients undergoing VSG is unknown. METHODS Four hundred and eighty patients undergoing VSG are the subject of this study. Three surgeons at a single institution performed the procedures. The remnant stomach was sent to pathology and tested for the presence of H. pylori using immunohistochemistry. All patients were discharged on proton pump inhibitors. RESULTS Of the 480 patients who underwent VSG, 52 were found to be H. pylori positive based on pathology. There was no statistically significant difference in age (p = 0.77), sex (p = 0.48), or BMI (p = 0.39) between the groups. There were 17 readmissions post-op. Five of these were in the H. pylori positive cohort. Six of these complications were classified as severe (anastomotic leak, intra-abdominal collection, or abscess), with two in the H. pylori positive cohort (Table 1). There was no statistically significant difference in the severe complication rates between the two groups (p = 0.67). There were no readmissions for gastric or duodenal ulceration or perforation. CONCLUSIONS Our data suggests that there is no increase in early complications in patients with H. pylori undergoing VSG. If these findings are confirmed in a long-term follow-up, it would mean that preoperative H. pylori screening in patients scheduled for VSG is not necessary.
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Affiliation(s)
- Andrew R Brownlee
- Department of Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10075, USA.
| | - Erica Bromberg
- Department of Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10075, USA
| | - Mitchell S Roslin
- Department of Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10075, USA
- Northern Westchester Hospital Center, Mt Kisco, NY, USA
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17
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Gomberawalla A, Lutfi R. Early Outcomes of Helicobacter Pylori and Its Treatment after Laparoscopic Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2015. [DOI: 10.1089/bari.2014.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ameer Gomberawalla
- Department of Surgery, Presence Saint Joseph Hospital, Chicago, Illinois
- Department of Surgery, Chicago Institute of Advanced Bariatrics, Chicago, Illinois
| | - Rami Lutfi
- Department of Surgery, Chicago Institute of Advanced Bariatrics, Chicago, Illinois
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18
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Rossetti G, Moccia F, Marra T, Buonomo M, Pascotto B, Pezzullo A, Napolitano V, Schettino P, Avellino M, Conzo G, Amato B, Docimo G, Tolone S, Del Genio G, Docimo L, Fei L. Does helicobacter pylori infection have influence on outcome of laparoscopic sleeve gastrectomy for morbid obesity? Int J Surg 2014; 12 Suppl 1:S68-71. [PMID: 24862673 DOI: 10.1016/j.ijsu.2014.05.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Among the surgical procedures for treatment of morbid obesity, laparoscopic sleeve gastrectomy has known widespread diffusion in the last years, although it is not free from significant morbidity rates. Aim of this work is to evaluate the incidence of Helicobacter pylori (HP) infection on the postoperative outcome of patients undergoing laparoscopic sleeve gastrectomy. METHODS Between January 2008 and December 2013, 184 patients (65 males, 119 females), mean age 35.8 ± 5.7 years, affected with morbid obesity, mean BMI 46.6 ± 6.7, underwent laparoscopic sleeve gastrectomy. All the specimens at the end of the operation were analysed by the same pathologist. Histological grading was based on the Sidney classification. RESULTS Seventy-two of the patients (39.1%) were HP positive, while 112 (60.9%) were negative. No significant differences were observed between the HP+ and HP- group in terms of age, sex, weight, BMI, incidence of comorbidities and duration of follow-up. All the operations were completed via laparoscopic approach. No mortality was observed. Postoperative complications occurred in 5 patients (2.7%): three leaks (1.6%), all in the HP- group and two bleedings (1.1%), one in the HP+ and one in the HP- group. In two cases a reintervention was necessary. No significant differences were observed in the morbidity rates between the two groups. Overall mean excess weight loss at 6 months, 12 months and 24 months was respectively 47.4 ± 11.3%, 61.1 ± 12.4% and 68.4 ± 13.5%, with no significant differences between the HP+ and HP- groups. CONCLUSIONS HP infection seems not to influence postoperative outcome of patients operated of laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Gianluca Rossetti
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy.
| | - Francesco Moccia
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Teresa Marra
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Mattia Buonomo
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Beniamino Pascotto
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Angelo Pezzullo
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Vincenzo Napolitano
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Pietro Schettino
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Manuela Avellino
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Giovanni Conzo
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Italy
| | - Giovanni Docimo
- Division of General and Bariatric Surgery, School of Medicine, Second University of Naples, Italy
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, School of Medicine, Second University of Naples, Italy
| | - Gianmattia Del Genio
- Division of General and Bariatric Surgery, School of Medicine, Second University of Naples, Italy
| | - Ludovico Docimo
- Division of General and Bariatric Surgery, School of Medicine, Second University of Naples, Italy
| | - Landino Fei
- Department of Anaesthesiological, Surgical and Emergency Sciences, Division of Digestive Surgery, School of Medicine, Second University of Naples, Via Pansini Naples 5, 80131 Naples, Italy
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Carabotti M, D’Ercole C, Iossa A, Corazziari E, Silecchia G, Severi C. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol 2014; 20:647-653. [PMID: 24574738 PMCID: PMC3921474 DOI: 10.3748/wjg.v20.i3.647] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/12/2013] [Accepted: 11/30/2013] [Indexed: 02/07/2023] Open
Abstract
The present review summarizes the prevalence and active clinical problems in obese patients with Helicobacter pylori (H. pylori) infection, as well as the outcomes after bariatric surgery in this patient population. The involvement of H. pylori in the pathophysiology of obesity is still debated. It may be that the infection is protective against obesity, because of the gastritis-induced decrease in production and secretion of the orexigenic hormone ghrelin. However, recent epidemiological studies have failed to show an association between H. pylori infection and reduced body mass index. H. pylori infection might represent a limiting factor in the access to bariatric bypass surgery, even if high-quality evidence indicating the advantages of preoperative H. pylori screening and eradication is lacking. The clinical management of infection is complicated by the lower eradication rates with standard therapeutic regimens reported in obese patients than in the normal-weight population. Prospective clinical studies to ameliorate both H. pylori eradication rates and control the clinical outcomes of H. pylori infection after different bariatric procedures are warranted.
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20
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Miyashita T, Miwa K, Inokuchi M, Nakagawara H, Tajima H, Takamura H, Ninomiya I, Kitagawa H, Fushida S, Fujimura T, Hattori T, Ohta T. Spontaneous clearance of Helicobacter pylori after pylorus-preserving gastrectomy for gastric cancer. Oncol Rep 2013; 30:299-303. [PMID: 23673508 DOI: 10.3892/or.2013.2472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/08/2013] [Indexed: 12/24/2022] Open
Abstract
Residual mucosa in the gastric stump after pylorus-preserving gastrectomy (PPG) is considered a risk factor for the development of gastric stump carcinoma (GSC). Duodenogastric reflux (DGR) and Helicobacter pylori (H. pylori) infection are suspected to contribute to the development of GSC. The aim of this study was to investigate the prevalence of H. pylori in the residual stomach after PPG for gastric cancer and to assess factors associated with the presence of H. pylori. We investigated 72 patients who had undergone PPG at least 1 year prior to the study and were confirmed to be positive for H. pylori infection on presurgical endoscopic biopsy. The extent of DGR, the prevalence of H. pylori infection based on H. pylori stool antigen (HpSA) tests and the severity of gastritis were analyzed in these post-PPG patients. None of the patients had DGR, as shown by (99m)Tc-PMT. Of the 72 post-PPG patients, 33 (46%) were positive for HpSA. The prevalence of H. pylori infection was significantly lower after surgery than before surgery. The endoscopic severity of remnant gastritis, as well as histological inflammation and activity, were higher in H. pylori-positive patients than in H. pylori-negative patients. In conclusion, some patients who undergo PPG and are negative for DGR experience spontaneous clearance of H. pylori infection.
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Affiliation(s)
- Tomoharu Miyashita
- Department of Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan.
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Bradfield JP, Taal HR, Timpson NJ, Scherag A, Lecoeur C, Warrington NM, Hypponen E, Holst C, Valcarcel B, Thiering E, Salem RM, Schumacher FR, Cousminer DL, Sleiman PMA, Zhao J, Berkowitz RI, Vimaleswaran KS, Jarick I, Pennell CE, Evans DM, St Pourcain B, Berry DJ, Mook-Kanamori DO, Hofman A, Rivadeneira F, Uitterlinden AG, van Duijn CM, van der Valk RJP, de Jongste JC, Postma DS, Boomsma DI, Gauderman WJ, Hassanein MT, Lindgren CM, Mägi R, Boreham CAG, Neville CE, Moreno LA, Elliott P, Pouta A, Hartikainen AL, Li M, Raitakari O, Lehtimäki T, Eriksson JG, Palotie A, Dallongeville J, Das S, Deloukas P, McMahon G, Ring SM, Kemp JP, Buxton JL, Blakemore AIF, Bustamante M, Guxens M, Hirschhorn JN, Gillman MW, Kreiner-Møller E, Bisgaard H, Gilliland FD, Heinrich J, Wheeler E, Barroso I, O'Rahilly S, Meirhaeghe A, Sørensen TIA, Power C, Palmer LJ, Hinney A, Widen E, Farooqi IS, McCarthy MI, Froguel P, Meyre D, Hebebrand J, Jarvelin MR, Jaddoe VWV, Smith GD, Hakonarson H, Grant SFA. A genome-wide association meta-analysis identifies new childhood obesity loci. Nat Genet 2012; 44:526-31. [PMID: 22484627 PMCID: PMC3370100 DOI: 10.1038/ng.2247] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/14/2012] [Indexed: 12/19/2022]
Abstract
Multiple genetic variants have been associated with adult obesity and a few with severe obesity in childhood; however, less progress has been made in establishing genetic influences on common early-onset obesity. We performed a North American, Australian and European collaborative meta-analysis of 14 studies consisting of 5,530 cases (≥95th percentile of body mass index (BMI)) and 8,318 controls (<50th percentile of BMI) of European ancestry. Taking forward the eight newly discovered signals yielding association with P < 5 × 10(-6) in nine independent data sets (2,818 cases and 4,083 controls), we observed two loci that yielded genome-wide significant combined P values near OLFM4 at 13q14 (rs9568856; P = 1.82 × 10(-9); odds ratio (OR) = 1.22) and within HOXB5 at 17q21 (rs9299; P = 3.54 × 10(-9); OR = 1.14). Both loci continued to show association when two extreme childhood obesity cohorts were included (2,214 cases and 2,674 controls). These two loci also yielded directionally consistent associations in a previous meta-analysis of adult BMI(1).
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Affiliation(s)
- Jonathan P Bradfield
- Center for Applied Genomics, Abramson Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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