Early Effects of Helicobacter pylori Infection in Patients Undergoing Bariatric Surgery

Abstract

Hypothesis: Following weight loss surgery, many patients initially experience nonspecific foregut symptoms. Helicobacter pylori infection of the gastric remnant may be associated with foregut symptoms. Design: Inception cohort. Setting: University hospital. Patients: Ninety-nine consecutive patients being evaluated for weight loss surgery. Intervention: All patients underwent preoperative esophagogastroduodenoscopy and H pylori testing. Main Outcome Measures: Foregut symptoms were documented at routine post-weight loss surgery follow-up visits. Results: Preoperatively, 24% of patients tested positive for H pylori. Postoperative foregut symptoms were significant in 48% of the H pylori-positive group, and 19% of the H pylori-negative group (P = .02). This increase remained even after controlling for age, sex, preoperative presence of antritis, type of surgery performed, and body mass index (odds ratio, 3.6; 95% confidence interval,1.1-11.8). Patients with prolonged symptoms who tested positive for H pylori were given an eradication treatment. Conclusions: The prevalence of H pylori infection in patients undergoing weight loss surgery is high, and a significant proportion of them have postoperative foregut symptoms. Consideration should be given to H pylori treatment in these patients.

Preoperative bariatric screening and treatment of Helicobacter pylori

“…Our incidence of H. pylori infection (12%) was lower than the 28% combined incidence published using 526 patients in five different studies [4]. Significant variability exists in the incidence of H. pylori found in several studies ranging from 11% to 67% [1,4]; this is most likely due to geographical and socioeconomic differences within the populations studied. We speculate that in part because of our low incidence of H. pylori infections and the comparatively small tested group, we were unable to demonstrate a statistical difference between the two groups.…”

“…In contrast, a small body of literature suggests that H. pylori infection may actually increase postoperative complications [1,5]. We hypothesize that preoperative detection and eradication of H. pylori infection may decrease the incidence and/or severity of peptic ulcer-related problems following Roux-en-Y gastric bypass.…”

“…H. pylori infection has a prevalence of 24-67% among bariatric patients and infection has been associated with a higher incidence of early postoperative foregut symptoms [1]. Some authors have endorsed routine preoperative esophagogastroduodenoscopy (EGD) with concurrent H. pylori screening and biopsy to rule out pathologic abnormalities (e.g., esophagitis, polyps, hiatal hernia, gastritis, duodenitis, Schatzki ring, and malignant lesions) reported to be present in up to 91% of bariatric candidates [2,3].…”

“…The incidence of postoperative marginal ulcer, gastrointestinal (GI) bleeding, and GI perforations is 3.4, 0.3-2.2, and 0.3-0.5%, respectively [4]. A small number of studies have suggested that the incidence of these complications is higher in patients infected with H. pylori [1,5].…”

The Eradication of Helicobacter pylori is Affected by Body Mass Index (BMI)

“…It has been shown to be safe and adequate in inducing sustainable and important weight loss [2], and it is also recommended for the treatment of comorbid diseases, including diabetes mellitus, hypertension, sleep apnea, and degenerative joint disease [2,3]. As part of the workup for bariatric surgery, most surgeons have long advocated routine preoperative Helicobacter pylori (H. pylori) testing and, if necessary, eradication therapy [1,[4][5][6][7][8][9][10]. The prevalence of the infection in patients undergoing weight-loss surgery is reported to be 24% to 67% [1,4,[11][12][13].…”