Mide İçi Botulinum Toksini Enjeksiyonunun Obezite Tedavisindeki Başarısında Helicobacter pylori Pozitifliği Bir Faktör müdür?

Öz

Giriş ve Amaç: Obezite dünya çapında giderek yaygınlaşmaktadır. Son yıllarda obezite tedavisinde pek çok gelişme yaşansa da endoskopik tedavi yöntemleri, davranışsal tedavilere göre yan etkilerinin düşük olması ve başarı oranının daha yüksek olması nedeniyle önemli bir yere sahiptir. İntragastrik Botulinum toksin enjeksiyonu ile ilgili yapılan çalışmalarda kafa karıştırıcı sonuçlar olmasına rağmen bunun sebebi hala açıklığa kavuşturulamamıştır. Bu çalışmadaki amacımız Helicobacter pylori enfeksiyonunun intragastrik Botulinum toksin enjeksiyon tedavisi başarısı üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntem: On sekiz ile 65 yaşları arasında, vücut kitle indeksi 25 kg/m2'nin üzerinde ve en az bir obezite ile ilişkili komplikasyonu olan veya komplikasyon olmadan vücut kitle indeksi 30 kg/m2'den fazla olan 80 hasta çalışmaya dahil edildi. Helicobacter pylori değerlendirmesi için intragastrik Botulinum toksini uygulaması esnasında mide antrumundan biyopsiler alındı ve hastalar Helicobacter pylori pozitifliği veya negatifliğine göre iki gruba ayrıldı. Bulgular: Çalışmamızda her iki grupta da başlangıç kilolarına göre istatistiksel olarak anlamlı azalma görüldü (p < 0.001). Ancak mide mukozasında Helicobacter pylori varlığı veya yoğunluğunun kilo kaybı üzerinde istatistiksel olarak anlamlı bir etkisi yoktu. Sonuç: İntragastrik Botulinum toksini uygulamasında çelişkili sonuçlara neden olabilecek durumlardan biri olan Helicobacter pylori enfeksiyonunun kilo kaybına etkisinin olmadığı gösterilmiştir.

Anahtar Kelimeler

• Obezite
• botulinum
• Helicobacter pylori
• vücut kitle indeksi
• endoskopik tedavi
• intragastrik enjeksiyon

Is Helicobacter pylori Positiveness a factor in the Success of the Intragastric Injection of Botulinum Toxin in the Treatment of Obesity?

Öz

Background and Aims: Obesity is becoming more common around the world. Although there have been many developments in the treatment of obesity recently, endoscopic treatment methods have an important place due to their low side effects and higher success rate compared to behavioral treatments. Although studies on intragastric botulinum toxin injection have had confusing results, the reason why the treatment causes these different results has not been clarified. Our aim in this study was to evaluate the presence of Helicobacter pylori infection, which may affect the success of intragastric botulinum toxin injection treatment. Materials and Methods: Patients with a body mass index of greater than 25 kg/m2 and at least one obesity-related complication, or a body mass index of greater than 30 kg/m2 without complications, were eligible for the study if they were between the ages of 18 and 65. In all patients, a biopsy was taken for Helicobacter pylori evaluation from the stomach antrum simultaneously with intragastric botulinum toxin administration. Results: In our study on 80 patients, compared to their beginning weight, the patients' weights in all groups decreased statistically significantly (p  0.001). However, neither Helicobacter pylori density nor Helicobacter pylori presence had a statistically significant impact on weight loss in the second or sixth months. Conlusion: It has been shown that Helicobacter pylori infection, which is one of the conditions that may cause conflicting results of intragastric botulinum toxin administration, has no effect on weight loss.

Anahtar Kelimeler

• Obesity
• botulinum
• Helicobacter pylori
• body mass index
• endoscopic treatment
• intragastric injection

Kaynakça

1. 1. Engin A. Adiponectin-resistance in obesity. In: Engin AB, Engin A, (Eds). Obesity and Lipotoxicity (eBook). Springer, 2017:415-41.
2. 2. Chakhtoura M, Haber R, Ghezzawi M, et al. Pharmacotherapy of obesity: An update on the available medications and drugs under investigation. EClinicalMedicine. 2023:58:101882.
3. 3. Gulinac M, Miteva DG, Peshevska-Sekulovska M, et al. Long-term effectiveness, outcomes and complications of bariatric surgery. World J Clin Cases. 2023;11(19):4504-12.
4. 4. Alexandre F, Lapergola A, Vannucci M, et al. Endoscopic management of obesity: Impact of endoscopic sleeve gastroplasty on weight loss and co-morbidities at six months and one year. J Visc Surg. 2023;160(2S):S38-S46.
5. 5. Štimac D, Klobučar Majanović S, Belančić A. Endoscopic treatment of obesity: from past to future. Dig Dis. 2020;38(2):150-62.
6. 6. Bang CS, Baik GH, Shin IS, et al. Effect of intragastric injection of botulinum toxin A for the treatment of obesity: a meta-analysis and meta-regression. Gastrointes Endosc. 2015;81(5):1141-9. e7.
7. 7. Bustamante F, Brunaldi VO, Bernardo WM, et al. Obesity Treatment with Botulinum Toxin-A Is Not Effective: a Systematic Review and Meta-Analysis. Obes Surg. 2017;27(10):2716-2723.
8. 8. Gravina AG, Zagari RM, De Musis C, et al. Helicobacter pylori and extragastric diseases: A review. World J Gastroenterol. 2018;24(29):3204-21.

9. 9. Blaser MJ. Hypothesis: the changing relationships of Helicobacter pylori and humans: implications for health and disease. J Infect Dis. 1999;179(6):1523-30.
10. 10. Welsh C, Jarrin J, Daneman A, Belik J. In vivo ultrasound assessment of gastric emptying in newborn mice. J Pediatr Gastroenterol Nutr. 2015;60(3):322-6.
11. 11. Alzahrani S, Lina TT, Gonzalez J, et al. Effect of Helicobacter pylori on gastric epithelial cells. World J Gastroenterol. 2014;20(36):12767-80.
12. 12. Adler I, Muiño A, Aguas S, et al. Helicobacter pylori and oral pathology: relationship with the gastric infection. World J Gastroenterol. 2014;20(29):9922-35.
13. 13. Wouters M, Boeckxstaens G. Is there a causal link between psychological disorders and functional gastrointestinal disorders? : Taylor & Francis; 2016. p. 5-8.
14. 14. Adler I, Muiño A, Aguas S, et al. Helicobacter pylori and oral pathology: relationship with the gastric infection. World J Gastroenterol. 2014;20(29):9922-35.
15. 15. Pero R, Coretti L, Lembo F. Botulinum Toxin A for Controlling Obesity. Toxins (Basel). 2016;8(10):281.
16. 16. Gui D, Mingrone G, Valenza V, et al. Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study. Aliment Pharmacol Ther. 2006;23(5):675-80.
17. 17. Gui D, De Gaetano A, Spada PL, et al. Botulinum toxin injected in the gastric wall reduces body weight and food intake in rats. Aliment Pharmacol Ther. 2000;14(6):829-34.
18. 18. Coskun H, Duran Y, Dilege E, et al. Effect on gastric emptying and weight reduction of botulinum toxin-A injection into the gastric antral layer: an experimental study in the obese rat model. Obes Surg. 2005;15(8):1137-43.
19. 19. Foschi D, Corsi F, Lazzaroni M, Sangaletti O, Riva P, La Tartara G, Bevilacqua M, Osio M, Alciati A, Bianchi Porro G, Trabucchi E. Treatment of morbid obesity by intraparietogastric administration of botulinum toxin: a randomized, double-blind, controlled study. Int J Obes (Lond). 2007;31(4):707-12.
20. 20. Mittermair R, Keller C, Geibel J. Intragastric injection of botulinum toxin A for the treatment of obesity. Obes Surg. 2007;17(6):732-6.
21. 21. Topazian M, Camilleri M, Enders FT, et al. Gastric antral injections of botulinum toxin delay gastric emptying but do not reduce body weight. Clin Gastroenterol Hepatol. 2013;11(2):145-50.e1.
22. 22. de Moura EGH, Ribeiro IB, Frazão MSV, et al. EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial. Obes Surg. 2019;29(1):32-39.
23. 23. Rollnik JD, Meier PN, Manns MP, Göke M. Antral injections of botulinum a toxin for the treatment of obesity. Ann Intern Med. 2003;138(4):359-60.
24. 24. Rhee PL, Lee JY, Son HJ, et al. Analysis of pacemaker activity in the human stomach. J Physiol. 2011;589(Pt 24):6105-18.
25. 25. Xing J, Chen JD. Alterations of gastrointestinal motility in obesity. Obes Res. 2004;12(11):1723-32.
26. 26. Badurdeen DS, Fayad L, Kalloo AN, Kumbhari V. The forgotten fundus—response to-obesity treatment with botulinum toxin-A is not effective: a systematic review and meta-analysis. Obes Surg. 2018;28(1):262-3.
27. 27. Chang PC, Jhou HJ, Chen PH, et al. Intragastric Botulinum Toxin A Injection Is an Effective Obesity Therapy for Patients with BMI > 40 kg/m2: a Systematic Review and Meta-analysis. Obes Surg. 2020;30(10):4081-90.
28. 28. Theodoridis X, Chourdakis M, Haidich AB, et al. Treatment of obesity with intragastric injection of botulinum toxin. Is it worth the pinch? An overview of systematic reviews and meta-analysis. Obes Res Clin Pract. 2023;17(3):184-91.
29. 29. Ukleja A, Tandon K, Shah K, Alvarez A. Endoscopic botox injections in therapy of refractory gastroparesis. World J Gastrointest Endosc. 2015;7(8):790-8.
30. 30. Youssef T, Abdalla E, El-Alfy K, et al. Impact of Botulinum Neurotoxin Pyloric Injection During Laparoscopic Sleeve Gastrectomy on Postoperative Gastric Leak: a Clinical Randomized Study. Obes Surg. 2016;26(3):494-504.
31. 31. Manes G, Malfertheiner P. Relationship of Helicobacter pylori infection with gastrointestinal motility. Ital J Gastroenterol Hepatol. 1999;31(8):705-12.
32. 32. Nweneka CV, Prentice AM. Helicobacter pylori infection and circulating ghrelin levels - a systematic review. BMC Gastroenterol. 2011;11:7.
33. 33. Ashraf AA, Gamal SM, Ashour H, et al. Investigating Helicobacter pylori-related pyloric hypomotility: functional, histological, and molecular alterations. Am J Physiol Gastrointest Liver Physiol. 2021;321(5):G461-G476.
34. 34. Peleteiro B, Bastos A, Ferro A, Lunet N. Prevalence of Helicobacter pylori infection worldwide: a systematic review of studies with national coverage. Dig Dis Sci. 2014;59(8):1698-709. Erratum in: Dig Dis Sci. 2015;60(9):2849.
35. 35. Ozaydin N, Turkyilmaz SA, Cali S. Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test. BMC Public Health. 2013;13:1215.