Gastric biomarkers and their dynamics as a less invasive method to evaluate stomach health in bariatric surgery patients
Date
2023-10-25
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Abstract
Paralleelselt rasvunute arvu suurenemisega on tõusnud bariaatriliste operatsioonide arv maailmas. Raskekujulise rasvumise korral on kirurgiline sekkumine ainus tõhus ja kestvat toimet tagav ravimeetod. Bariaatriliste patsientide pre- ja postoperatiivses käsitluses on mao seisundi hindamise kuldseks standardiks seedetrakti ülaosa endoskoopiline uuring (koos gastrobiopsiatega). Viimastel aastakümnetel on populaarsust kogunud vereproovil baseeruv biomarkerite testpaneel, mis aitab väheinvasiivset meetodit kasutades diagnoosida mao funktsionaalseid muutusi ja limaskesta patoloogiaid. Testpaneel põhineb neljal maospetsiifilisel biomarkeril (Pepsinogeen I ja II, Gastriin-17, Helicobacter pylori antikeha), mille väärtuste põhjal saab eristada 8 erinevat markerite profiili. Käesoleva doktoritöö eesmärgiks oli välja selgitada: 1) kas biomarkerite testi abil oleks võimalik vältida invasiivse endoskoopilise uuringu tegemist bariaatrilisele operatsioonile minevatele patsientidele; 2) kirjeldada mao biomarkerite profiili muutust 2 aasta jooksul peale maovähendusoperatsiooni; 3) hinnata, kas postoperatiivselt tekkinud muutused mao biomarkerite profiilis on seotud operatsioonist tingitud anatoomiliste muutustega või on nende põhjuseks mao limaskesta patohistoloogilised muutused; 4) hinnata, kas mao biomarkerite pre- ja postoperatiivsed väärtused korreleeruvad ühe aasta liigse kehakaalu langusega. Uuring baseerus 105 patsiendi andmetel, kellele teostati Tartu Ülikooli Kliinikumi kirurgikliinikus mao vertikaalne resektsioon või maost möödajuhtiv operatsioon. Uuringu tulemustest selgus, et biomarkerite testpaneeli normaalsed väärtused peegeldavad hästi terve mao seisundit, mistõttu võiks antud test asümptomaatilistel rasvunud patsientidel normaalsete väärtuste korral asendada preoperatiivset endoskoopilist uuringut. Käesoleva uuringu tulemuste alusel oleks preoperatiivne endoskoopiline uuring olnud välditav 31% uuringu patsientidest. Meie uurimistöö tulemused näitavad, et bariaatrilise operatsiooni järgselt toimuvad märkimisväärsed muutused biomarkerite profiilis on põhjustatud operatsioonist, kuid mitte mao limaskesta patoloogiast. Muutused biomarkerite tasemes püsivad stabiilsena vähemalt kaks aastat peale operatsiooni.
In parallel to the growth of obese people, the number of bariatric operations has increased, since it is the only effective way to treat obesity, resulting in sustainable and significant weight loss in the long term. Upper digestive endoscopy with gastrobiopsies is the gold standard in pre– and postoperative investigations of bariatric patients. During past decades, the use of serological biomarker testing has gained increasing popularity as a non-invasive diagnostic tool to diagnose functional disorders of the stomach and gastric diseases. The testpanel consists of 4 stomach-specific biomarkers (Pepsinogens I and II, Gastrin-17 and Helicobacter pylori antibody) and, based on their values, it distinguishes between 8 diagnostic biomarker profiles. The aims of our study were: 1) to find out if less invasive serological biomarker testing could avoid invasive preoperative endoscopies in obese patients referred for bariatric surgery; 2) to describe changes in the gastric biomarker profile up to 2-year follow-up of bariatric surgery; 3) to evaluate whether postoperative gastric biomarker changes are related to operation and anatomical changes alone, or whether there could occur also some patohistological alterations of the gastric mucosa; 4) to evaluate whether preoperative, postoperative or preoperative/postoperative rate of stomach-specific biomarkers is correlated with excess weight loss at 1-year follow-up. The whole study is based on the data of 105 patients who underwent sleeve gastrectomy or gastric bypass operation at the Surgery Clinic of Tartu University Hospital. The results of our study confirm that the normal biomarker profile in the testpanel is an excellent surrogate for the healthy stomach; therefore, this non-invasive test could replace preoperative endoscopy in asymptomatic obese patients with the normal biomarker profile. According to the results of our study, preoperative endoscopy could have been avoided in 31% of the patients. Our study demonstrates that significant changes in the biomarker profile after bariatric surgery are caused by the operation and do not indicate pathological changes in the gastric mucosa. Changes in biomarker levels are stable for at least 2 years postoperatively.
In parallel to the growth of obese people, the number of bariatric operations has increased, since it is the only effective way to treat obesity, resulting in sustainable and significant weight loss in the long term. Upper digestive endoscopy with gastrobiopsies is the gold standard in pre– and postoperative investigations of bariatric patients. During past decades, the use of serological biomarker testing has gained increasing popularity as a non-invasive diagnostic tool to diagnose functional disorders of the stomach and gastric diseases. The testpanel consists of 4 stomach-specific biomarkers (Pepsinogens I and II, Gastrin-17 and Helicobacter pylori antibody) and, based on their values, it distinguishes between 8 diagnostic biomarker profiles. The aims of our study were: 1) to find out if less invasive serological biomarker testing could avoid invasive preoperative endoscopies in obese patients referred for bariatric surgery; 2) to describe changes in the gastric biomarker profile up to 2-year follow-up of bariatric surgery; 3) to evaluate whether postoperative gastric biomarker changes are related to operation and anatomical changes alone, or whether there could occur also some patohistological alterations of the gastric mucosa; 4) to evaluate whether preoperative, postoperative or preoperative/postoperative rate of stomach-specific biomarkers is correlated with excess weight loss at 1-year follow-up. The whole study is based on the data of 105 patients who underwent sleeve gastrectomy or gastric bypass operation at the Surgery Clinic of Tartu University Hospital. The results of our study confirm that the normal biomarker profile in the testpanel is an excellent surrogate for the healthy stomach; therefore, this non-invasive test could replace preoperative endoscopy in asymptomatic obese patients with the normal biomarker profile. According to the results of our study, preoperative endoscopy could have been avoided in 31% of the patients. Our study demonstrates that significant changes in the biomarker profile after bariatric surgery are caused by the operation and do not indicate pathological changes in the gastric mucosa. Changes in biomarker levels are stable for at least 2 years postoperatively.
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Keywords
gaster, biomarkers, bariatric surgery, preoperative period, postoperative period