Doctoral defence: Jaanus Suumann „Gastric biomarkers and their dynamics as a less invasive method to evaluate stomach health in bariatric surgery patients“

On November 24th Jaanus Suumann will defend his thesis „Gastric biomarkers and their dynamics as a less invasive method to evaluate stomach health in bariatric surgery patients“.

Supervisors: 
Associate professor Toomas Sillakivi, University of Tartu
Professor Ants Peetsalu, University of Tartu (until 2020)

Opponent: 
Professor Almantas Maleckas, Lithuanian University of Health Sciences (Kaunas, Lithuania)

Summary:
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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