麻豆传媒

KISSIMMEE, Fla. -- Researchers reported fairly significant prevalence of Helicobacter pylori gastritis in sleeve gastrectomy specimens.

In one retrospective study that evaluated 284 sleeve gastrectomy specimens over 5 years, with ancillary studies performed in 61 cases, 6.7% of the total cohort had a first-time diagnosis of H. pylori gastritis, according to Joyce Ren, MD, of Stony Brook Medicine in Stony Brook, New York.

"Atypical patterns of inflammation should prompt the pathologist to pursue further workup, such that proper treatment may be initiated," Ren and colleagues wrote in a poster presentation at the College of American Pathologists (CAP) annual meeting. "Incidental findings on sleeve gastrectomy specimens can have important clinical implications. Proper treatment for H. pylori gastritis may prevent complications such as peptic ulcer disease, gastric cancer, and gastric lymphoma."

In a second CAP poster, a researcher from Beaumont Hospital in Royal Oak, Michigan, reported a total of 7.62% positive cases for H. pylori infection in sleeve gastrectomy specimens.

H. pylori gastritis has been reported to be , Ren and colleagues stated. For their study, the histologic features that prompted the ancillary studies were active chronic gastritis (nine cases), inactive chronic gastritis (seven cases), and prominent lymphoid follicles (four cases).

Treatment was initiated immediately in 14 cases. Additionally, hematopathology consultations were obtained for three cases because of the presence of prominent lymphoid aggregates in the absence of H. pylori. Further workup revealed incidental monoclonal B-cell lymphoproliferative process in two of the cases, confirmed by B-cell receptor gene rearrangement by polymerase chain reaction, the authors noted.

"Clinically, before these patients underwent surgery, there was no indication that they had H. pylori infection," Ren explained. "Hematoxylin and eosin staining was employed to identify seven cases of H. pylori; an immunostain or special stain was performed in 12 cases."

She said the nearly 7% capture rate for H. pylori infection was high enough to encourage clinicians to look for the infection among sleeve gastrectomy candidates.

However, she cautioned that "Some people say that obesity has no relationship to H. pylori. Our study was only looking at obese individuals undergoing sleeve gastrectomy so we don't know the prevalence of the infection in people who are not morbidly overweight."

Ren added that in Europe, patients undergoing sleeve gastrectomy are for H. pylori infection, but U.S. guidelines do not recommend that testing, so only patients with symptoms of H. pylori infections would routinely be tested for evidence of the infection.

In the second study, Subhashree Krishnan, DO, reported a case in which a morbidly obese women undergoing sleeve gastrectomy had a 1.3-cm pancreatic tissue polyp and inflammation in her tissue sample, both potential indicators of H. pylori. While the H. pylori immune stain was negative in her acute inflamed gastric tissue, Krishnan said the case prompted her group to review previous cases of sleeve gastrectomy for H. pylori involvement.

"When we looked into it, we found there were a substantial number of cases in which patients undergoing sleeve gastrectomy did have undiagnosed H. pylori infection," she said.

They reviewed 223 sleeve gastrectomy cases from 2017 to 2018, and in 17 instances, H. pylori involvement was confirmed. Krishnan told 麻豆传媒 that the finding of H. pylori occurred often enough for her to recommend that sleeve gastrectomy tissue specimens should be submitted for histopathologic examination.

"We think our work adds to the literature in this field, and may encourage other teams to review their cases as well," Krishnan said. "We know that H. pylori gastritis can lead to other complications, including the development of MALT [mucosa-associated lymphoid tissue] tumors. In these cases, patients are being treated for bariatric reasons, but if we find H. pylori incidentally and we treat it, we can save these patients from having other serious complications."