Role of Adiponectin in Endoscopic Gastritis

1department of clinical biochemistry, al-Kindy college of Medicine, university of baghdad, iraq. 2department of Surgery, al-Kindy college of Medicine, university of baghdad, iraq. 3cabM, ficMS, al-Kindy Teaching Hospital, iraq. 4consultant clinical immunology, Head of Hla research unit, department of Microbiology, al-Kindy college of Medicine, baghdad university, iraq. 5bSc chemical Science, iraq.

Endoscopic gastritis is a term used when there is an inflammatory change in the gastric mucosa like color and/or structure that was noticed by endoscope 1,2 . This can be defined by flat depressed white spot surrounded by reddish area with superficial bleeding or small elevated area with umblication in the center 3 . There are many factors effect upper gastrointestinal diseases like gastritis, gastric ulcer, deoudenitis and gastroesophageal reflux disease. One of these important factors is body mass index (BMI) which is known to be associated with gastritis 4 . There are several studies showed the association and potential effect of obesity on gastritis 5,6 . Yamamoto et al. showed that BMI was significantly higher and the serum adiponectin level was significantly lower in gastritis-positive patients than in gastritisnegative patients 7 . This study demonstrated the association between hypoadiponectinemia and erosive gastritis, adding to that other studies showed that low plasma adiponectin levels had a role in gastric cancer 8,9 . So adipose tissue is an important endocrine organ secreting a large number of endocrine factors like adiponectin that had wide physiological functions 10 . Increase in its serum level protect against many diseases 11 . Other factor that leads to gastritis is infection with Helicobacter pylori that involves in progression to atrophy , intestinal metaplasia and gastric cancer 12 . After the discovery of H. pylori in 1983, these bacteria is an important factor in gastritis and its prevalence was decreased in Western countries and in some Asian countries like Japan 13 . It found that treatment and eradication of these bacteria leads to increased circulating adiponectin levels in Japanese patients and could be helpful for preventing gastritis and its progression to other diseases 14 .
Consequently, there are several important factors that related with endoscopic gastritis like BMI, Helicobacter pylori, lipid profile and adiponectin. This study assesses the effect of these factors and association of adiponectin with these factors.

Patients and methods
This is a case-controlled study done by Al-Kindy College of Medicine from January 2017 to June 2018. The approval of medicinal morals board was obtained for contributors in this study. The proposal was accepted by the Al-Kindy College of Medicine and Al-Kindy Teaching Hospital. The knowledgeable permission was obtained from all of them. The Scientific and Ethical Committee of Al-kindy medical college and Al-Kindy Teaching Hospital had approved and registered the study. Written informed consents were obtained from the patients and control normal blood donors.
The inclusion criteria were patients complaining from dyspepsia, upper abdominal pain, acid regurgitation, heartburn The exclusion criteria were patients who had history of gastric surgery, peptic ulcer, gastric cancer, previous H. pylori eradication, esophageal avarices and patients who were on medications like antacids, H2 blockers, proton pump inhibitors and non-steroidal anti-inflammatory drugs.
Data were collected from 100 subjects. Eighty of them had gastritis by endoscopy Forty of them were H. pylori positive and the rest were H. pylori negative. The rest twenty persons were healthy control group. Demographic information's were taken like age, sex and others by questionnaire.

Endoscopy
All patients examined for upper gastrointestinal endoscopic using gastroscope: GIF-H260; Olympus, Tokyo, Japan and Display screen; Olympus OEV-261H liquid crystal display monitor; Olympus, Tokyo, Japan. Endoscopic examinations performed by well-trained gastroenterologists. The presence or absence of endoscopic gastritis was determined by endoscopist according to their criteria 15 .

Anthropometric Measurements
All measurement like weight, height, waist circumference, body mass index was calculated as weight in kilograms divided by the square of height in meters (16) Waist circumference was measured in centimeters (cm) 17 .

Biochemical analysis
Five ml of venous blood were obtained from all subjects. Serum were analysis for lipid profile (cholesterol, triglyceride, HDLP, LDLP (Human-Germany), adiponectin (Human-Germany), and H pylori (Eco test-Chain).

Statistical analysis
was done using MiniTab version 3.0 software. Data analysis was done using chi-square test for frequencies, while ANOVA test for means and standard deviation. Correlation coefficient used to assess the correlation between different parameters by Pearson correlation. P-value less than 0.05 were considered statistically significant.

RESultS And diScuSSion
The total numbers of study groups were one hundred subjects, forty of them were gastritis with H pylori infection and the other group was gastritis alone without H pylori infection and the rest were twenty control healthy subjects. There was no significant differences among their ages and gender (P=0.134 and P= 0.334 respectively)(table-1-).There was a significant increase in BMI(P=0.000), weight(P=0.000), waist circumference (P=0.018) in patients with gastritis with or without H pylori when compared with control group (Table-1).
In this study, adiponectin was significantly lower ( P=0.001) in gastritis patients whether infected (8.783±0.968) with H pylori or not (8.278 ±0.838) when compared with control group (9.119±0.1593) ( Table-1-). Regarding lipid profile , there was a significant in all parameters of lipid profile in gastritis patients than healthy group (Table-1 It has been reported that obesity and increased BMI are related to gastrointestinal symptoms and endoscopic gastritis. Adiponectin is an anti-inflammatory and its serum concentrations are reduced in obesity with increased visceral fat accumulation. In this study, gastritis developed when there is increased in BMI especially with H pylori infection. This is associated with decreased adiponctin serum level. This is in agreement with other results that showed adiponectin promotes ulcer healing, decrease ulcer area, reduce edema and leukocytes infiltration in submucosal layer 18,19 . It is well known that adiponectin is associated with better inflammation reduction and healing 20 . The gastric protective effect of adiponectin might be due to reduction of neutrophil infiltration, decrease in gastric motility and relaxation of circular muscles, flattening of the folds and reduce the volume of the gastric irritants on the rugal crest 21,22 . In addition to that, adiponectin activates AMP-activated protein kinase (AMPK) system that regulates growth arrest and apoptosis by stimulating p53 and p21 and decreases production of reactive oxygen species (ROS) which may result in decreased activation of mitogen-activated-protein-kinase (MAPK) 23,24,25 . So increase level of adiponectin reduce the risk of development of many diseases 26 . There is a negative correlation with body mass index and adeponectin in gastritis with H pylori and in general there is in agreement with other studies that demonstrated plasma adiponectin concentrations are inversely related to BMI, weight and waist circumference 27 . The possible mechanism is that during adipogenesis, a feedback inhibition in its production may occur due to increase in the production of other adipocytokines like TNF-± that decrease adipocyte expression and secretion of adiponectin 28 . In addition to that infection with H pylori leads to decrease in adiponectin serum level which in agreement with other studies 12,29 . This study demonstrated a negative correlation between adiponectin with Cholesterol, triglyceride and LDL. Adiponectin has been shown to regulate weight reduction as well as free fatty acid oxidation. The mechanism underlying this is regulation of production proteins associated with triglyceride metabolism including acyl CoA oxidase, activated protein kinase, and peroxisome proliferator-activated receptor ³ (PPAR³) which is in agreement with other studies 30 .

concluSionS
This study shows that adiponectin had an important role in gastritis especially when there is an h pylori infection. Its level had a negative correlation with BMI and lipid profile.