الفهرس 
Obesity (Obesity overview)Only 14 pages are availabe for public view
 |  | from | 98 |  |  |
| | | from | 98 | | |
Abstract
Obesity is the most common form of malnutrition. The excess morbidity or mortality attributable to obesity or obesity-related diseases exceeds that of tobacco and alcohol. There are more than 250 million obese people world-wide, equivalent to 7% of the adult population, and incidence continues to increase.
Obesity is associated with a large number of disease states. A 20% increase in body weight substantially increases the risk for hypertension, coronary artery disease, lipid disorders, and diabetes mellitus. Obesity is also considered a risk factor for some kinds of cancer and is associated with joint disease, gallstones, and respiratory problems.
The American society for metabolic and bariatric surgery states that actually the two most common bariatric surgery used are sleeve gastrectomy and Roux-en-y gastric by bass as they offer a better risk and benefit balance.
Multiple studies demonstrated that routine endoscopy before bariatric surgery can identify a variety of pathologies, including hiatal hernia, oesophagitis, and gastric ulcers. The majority of patients with pathology in these studies were asymptomatic. In addition,it was found that Helicobacter pylori infection is present in 30-40% of patients scheduled for bariatric surgery and is strongly associated with postoperative marginal ulceration, so preoperative testing in these patients which can be done using endoscopic tissue sample is useful.
This study done on 70 morbidly obese patients referred to GIT endoscopy unit, Tropical medicine, Menoufia University to undergo routine EGD to assess the upper GIT before undergoing bariatric surgery in Surgical department, Menoufia University over a period of one year from January 2019 to january2020. All patients met the inclusion and exclusion criteria.
The aim of this study was to assess the role of the role of EGD in assessment of patients undergoing bariatric surgery.
In current study, we classified 70 morbidly obese Patients to 4 groups according to endoscopic findings:
• group I: 13 patients (18.6%) had normal endoscopic findings.
• group II: 25 patients (35.7%) had abnormal endoscopic findings that do not change surgical approach or postpone bariatric surgery.
• group IIIa: endoscopic findings that changed surgical approach.
• group III b: 23 patients (32.9%) detected endoscopic findings that postponed bariatric surgery for medical treatment.
• group IV: EGD in 2 patients (2.9%) detected absolute contraindication to surgery.
All the included patients were subjected to the following:
• Full history taking with stress on gastrointestinal symptoms as heart burn, acid regurge, nausea, vomiting, hematemesis, melena, bleeding per rectum, epigastric pain and jaundice.
• Complete clinical examination including full cardiovascular, chest, musculoskeletal examination and abdominal examination.
7- laboratory investigations including: complete blood count, viral markers, liver function tests, renal function tests, lipid profile, bleeding and coagulation profile,thyroid Function tests and serum cortisol level.
Summary
71
• Radiological investigations: Electrocardiogram (ECG) Echocardiography Abdominal ultrasonography.
• General examinations for general condition, mental status and vital signs.
• Endoscopic procedure: 70 morbidly obese patients underwent upper gastrointestinal endoscopy before bariatric surgery after being counseled about its importance, risks and complications with acceptance to participate in this study.
In current study, 70 morbidly obese patients who were planned for undergoing bariatric surgery were included. They were 56 females (80%) and 14 males (20%) with an obvious female predominance Their age ranged between 18 and 53, and the mean age was 38.5 ± 8.8 years.The patients ranged from 115 to 180 kilograms in their body weight and the mean body weight was 141.7 ± 20.6 kilograms.according to their height,the mean height was 166.2 ± 8.6 centimeters and they ranged from 155 to 189 centimeters.also the mean BMI was52.3 ±11.89 kg\m2 and the patients ranged between 40.79 and 67.7 kg\m2.only 10 patients (14.3%) were smokers, all of them were males and 60 patients (85.7 %) were nonsmokers, all of them were females.
In current study, we observed abnormal endoscopic findings in 81.4% (57 patients).
In current study, regarding abnormal esophageal findings ranged from just incompetent cardia to grade D reflux esophagitis or even Barrett’s esophagitis. GERD was found in 67.1 % (47) patients: 25 patients had grade A reflux esophagitis, 15 patients had grade B reflux esophagitis, 6 patients had grade C reflux esophagitis while only one patient had grade D reflux esophagitis. Barrett’s esophagitis was 1.4% (one patient). Hiatus hernia was 31.4% (22 patients), 6 patients had large hiatus hernia (Hill grade III or IIII) while 16 patients had small size hiatus hernia (Hill grade I). One patient (1.4%) detected grade II esophageal varices with medium sized tortious veins occupying less than third esophageal lumen. Incompetent cardia was found in 31.4% (22 patients).
In current study, according to the gastric findings, 53 patients (75.7%) had abnormal findings. Mild diffuse gastritis was detected in 21 patients (30%), while mild antral gastritis was detected in 23pateints (32.9%) and erosive antral gastritis was detected in 2 patients (2.9%). Severe gastritis was detected in 4 patients. Prepyloric elevated gastric lesion that biopsied and revealed early gastric cancer with adenocarcinoma confined to mucosa only.
In current study, according to duodenal findings, mild duodenitis was detected in 7 patients (10%) while erosive bulb duodenitis detected in only one patient (1.4%), moderate duodenitis detected in 2 patients (2.9%) also 2 patients (2.9%) had severe duodenitis. Only one patient had a healed ulcer with clean base (Forrest 3) in the first part of duodenum while only one patient had ireactive and irregular pylorus
In the current study, H. pylori associated with severe gastritis, gastric ulcer, severe duodenitis and duodenal ulcer. 25 patients (35%) had infected with H. pylori.
In the current study the endoscopic findings in this study had clinical consequences in 32 patients (45.7%).
In our work, the operations of 23 (32.8%) patients were postponed 6 weeks due to endoscopic findings as severe gastritis, biliary gastritis, gastric ulcer and prepyloric polyps, severe duodenitis and duodenal ulcer while the type of bariatric surgery changed
Summary
72
from LSG to Roux-en-Y gastric bypass in 7 patients (10%), 6 patients with large hiatus hernia (Hill grade III or IV) with grade C or D reflux esophagitis and one patient had Barrett’s esophagitis.
In our work, only two patients (2.9%) were unfit and contraindicated to undergo bariatric surgery one of them detected grade II esophageal varices and the other detected early gastric cancer.
In current study there was a high statistical significant association between change the plane of surgery and (GERD symptoms, H.pylori and HH) as p value<.05.
In the present study there was a high statistical significant association between abnormal EGD findings and (GIT symptoms, H.pylori and Comorbid diseases).
In current study there was statistical significance association between H.pylori and (GERD symptoms, epigastric Pain and gastritis) as p value<.05. (Gastritis, Gastric Pain and GERD) is statistically significant in predicting of presence of H.pylori as (X2 =55.4,P=.0001, Nagelkerke R Square = 75%).The significant predictors were (Gastritis and Gastric Pain as odds ratio (95% CI) = {3.6(2.8-8), (p) =.0001}, {2.044 (1.18-3.54), (p) =.011 respectively).