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

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.

KEYWORDS:

• Bariatric
• immunohistochemistry
• obese
• LSG
• gastric atrophy
• microbiology
• cancer
• pathogen

Acknowledgements

We would like to thank the University of Tennessee Health Sciences Library Interlibrary Loan Staff, Wanda Booker-Wade, Paul Gahn, and Carolyn Polk for their exceptional assistance in procuring the required reference materials for our studies. We also thank the managers and histology scientists at Doctors Anatomic Pathology Services, St. Bernards Healthcare, Methodist Le Bonheur Healthcare, Idexx, St. Jude Children’s Research Hospital, and University of Tennessee DermPath laboratory for their ongoing support of the histotechnology curriculum at the University of Tennessee Health Science Center.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Study approval

This study was approved by the University of Tennessee Health Science Center Institutional Review Board ID 21–08515-XM.