Positive and Negative Helicobacter pylori Gastritis and its Correlation with Nutritional Status

Background: H. pylori gastritis can be related to people with obesity and metabolic syndrome. The mechanism underlying the relationship between them is suspected to be caused by adipocytokine called resistin. Objective: relationship with nutritional status. Method: This cross sectional study was done in the Gastroenterology department of General Hospital Adam Malik, Medan, from May to October 2019. Patients with gastritis diagnosed by endoscopy underwent rapid urease test (RUT), resistin, albumin, hemoglobin tests, also body mass index (BMI) and waist circumference (WC) were measured. Results: Conclusion: Resistin levels in gastritis with H. pylori positive are higher than H. pylori negative, body mass index and waist circumference have a strong relationship with resistin levels in patients with positive H. pylori gastritis, hemoglobin is lower in H. pylori positive than negative gastritis.


INTRODUCTION
caused by Helicobacter pylori, bile reflux, non- 1 The incidence of gastritis in Southeast Asia around 583,635 of the total population every year. 2 H.pylori is the most common cause of gastritis. The prevalence of H. pylori infection in peptic ulcer patients varies between 90-100% in Indonesia. 3 Adipose tissue in obesity have a biological role, not only play a role in triglycerides metabolic processes but also acts as an endocrine gland that secretes various cytokines and peptide hormones which play a role not only in regulating the balance of body weight process. Some of these substances are adiponectin, 4 Resistin is thought to have a role in the condition of insulin resistance. 5 Together with adiponectin, resistin has been a research topic for the past several decades. Hypoadiponectinemia is associated with various diseases, including gastritis. In previous studies it was said that the anti-inflammatory properties of adiponectin have a protective effect against gastrointestinal diseases. In contrast resistin has a 6 In addition, Samuel et. al showed that subjects who were lean and resistant to markers (MCP-1, IL-6 and resistin) than subjects who were overweight and still insulin sensitive. 7 There has been no report exploring resistin levels in H. pylori gastritis patients, we therefore studied the difference level of resistin between positive and negative H. pylori gastritis patients and their relationship with nutritional status (body mass index, waist circumference, hemoglobin, and albumin.

METHOD
This cross sectional study was conducted at the Endoscopic Unit of H. Adam Malik Hospital and other network hospital in Medan, North Sumatera, after obtaining approval from the Health Research Ethics Commission and related institutions. The time of the study was carried out on May to October 2019.
The inclusion criterias were men and women who are not pregnant aged 18-70 years, diagnosed with gastritis from endoscopic examination results histopathology. The exclusion criterias were patients who received H. pylori eradication therapy in the last 6 months or currently on antibiotic therapy which commonly used in eradication therapy, take Proton Pump Inhibitor, H2-receptor antagonist, non-steroid anti inflammation drugs, steroids, alcohol for the past 48 hours, patients with systemic diseases and malignancies, and the subject refused to participate.
Dyspepsia according to Rome III criteria is one quickly, epigastric pain, or burning sensation in the epigastrium that occurs in the last 3 months, with the onset of symptoms occurring at least 6 months before diagnosis. A 4 mL blood sample was inserted into the vacutainer tube without anticoagulation. Blood that has been taken is stored at room temperature for 30-45 minutes until the blood clots and then centrifuged at a speed of 3000 rpm for 15 minutes. The serum formed was put into 3 serum tubes, each as much as 0.5 mL for measurement of resistin, hemoglobin, albumin. Store type of serum sample). BMI is measured by comparing weight (in kilograms) to height (in meters squared). Waist circumference is measured on the abdomen above the umbilicus in centimeters (cm).
All endoscopic examinations using scopes (Olympus, Tokyo, Japan) in the endoscopic unit of H. Adam Malik Hospital. The endoscopic procedure was performed by an experienced endoscope who is the same at each subject examination. Endoscopy was done after the subject has fasted overnight (10-12 hours). Endoscopy was performed to look at the gastric mucosa whether it has edema, erythema (spotted, patchy, linear)/exudate/bleeding/ erosive; and retrieving networks for CLO checks.
To detect H. pylori, two biopsy specimens were each collected from the major curvature in the middle of the body and antrum of gastric. Serology (CLO) was performed by a gastroenterohepatologist who did the endoscopy.
This study used univariate analysis by analyzing the frequency distribution of independent and dependent variables, while bivariate analysis uses an independent T test if the data is normally distributed, and if the data is not normally distributed using the Mann Whitney test.
Nutritional status variables would be tested for correlation with resistin levels using Spearman correlation.

RESULTS
Sixty patients who met the inclusion criteria included in this study. A total of 34 patients (56.7%) were male and 26 patients (43.3%) were female. The average age is 46.5 years. The majority of respondents in the Batak ethnicity were 37 people (61.7%). Most of the patients who were respondents in this study were 27 employees (45%). The highest level of education is high school, 32 people (53.3%).
The mean BMI of respondents was 23.35 ± 3.98 kg/ m 2 . The mean waist circumference was 84.45 ± 8.24 cm, the median hemoglobin was 14 (10.4-16) g/dL, the average albumin was 4.5 ± 0.57 g/dL, and the median value resistin was 5.12 (2.12-10) ng/mL. By using the independent T-test, there were no significant differences found between BMI, waist circumference, and albumin in H. pylori gastritis with p values of 0.099, 0.055, and 0.528, respectively. Statistical analysis of hemoglobin with the Mann negative H. pylori with a p value of 0.009.  12 To determine the mechanism underlying the relationship between obesity and H. pylori gastritis, we examined the serum concentration of resistin in the same subject previously analyzed for the relationship of BMI with H. pylori gastritis, and found that the prevalence of H. pylori gastritis increased when resistin levels increased, using the Mann Whitney test found levels in patients with positive and negative H. pylori gastritis. The mean resistin in the group with H. pylori positive was higher with an average of 7.62 ng/mL while in the group with H. pylori negative with a mean of 3.23 ng/mL.
Higher levels of resistin was found in H. pylori gastritis. Although it has not been able to clarify the role of resistin in the pathogenesis of H. pylori gastritis in this study, it is suspected that resistin is indeed proresistin levels in H. pylori infection in humans has not yet been established.

DISCUSSION
The average age is 46.5 years in this study but not The characteristic baseline data in this study is also based on gender where the results of this study were 34 patients (56.7%) were male and 26 patients (43.3%) were female. Statistical analysis of sex relations with positive or negative H. pylori results (p = 0.768). This is in accordance with the study of Al-Zubaidi 8 , in obese and non-obese patients with positive H. pylori infections, found 65% were male, H. pylori (p = 0.200).
In terms of socio-economic demographic factors, most of the patients who were respondents in this study were 27 private employees (45%). The highest level of education is high school, 32 people (53.3%). However, a statistical analysis of the employment Resistin regulation in carbohydrate metabolism is thought to be associated with insulin resistance. Resistin is able to regulate the metabolism of insulinstimulated carbohydrates in many insulin target organs. 13 Since the discovery of resistin, most studies have focused the relationship of resistance to obesity and diabetes.
conditions and has been shown to be secreted in like-receptor-2 (TLR-2) through the NF-kB pathway. 14 Together with adiponectin, resistin has been a research topic for the past several decades. Hypoadiponectinemia is associated with various diseases, including gastritis. In previous studies it was said that the anti-inflammatory properties of adiponectin have a protective effect against gastrointestinal diseases. In contrast resistin has a 6 In addition, Samuel et al showed that subjects who were lean and resistant to markers (MCP-1, IL-6 and resistin) than subjects who were overweight and still insulin sensitive. 7 By using the Spearman correlation test of resistin with BMI in a group of patients with H. pylori positive, r 0.577 with p = 0.01, and with WC r 0.592 with p = 0.001 was found, meaning that there was a strong relationship between resistin levels with BMI and the levels of resistin in the three groups (p < 0.001), healthy control with BMI less than 25%. 15 In group II between serum resistin levels and BMI. There is a resistin level and hemoglobin level which indicates that an increase in hemoglobin level is associated with a decrease in resistin levels and vice versa.
However, to investigate whether resistin is related to H. pylori gastritis independently of body mass index, a multivariate analysis should be undertaken which includes other potential risk factors for gastritis, such as living habits (smoking, food, and drinking alcohol) as well as markers of serum metabolism (cholesterol, triglycerides, glucose, and insulin levels), in addition to body mass index, waist circumference, and resistin.

CONCLUSION
Resistin levels in gastritis with H. pylori positive are higher than H. pylori negative. Body mass index and waist circumference have a strong relationship with resistin levels in patients with positive H. pylori gastritis. Hemoglobin is found to be lower in H. pylori positive than negative gastritis.