How <i>Helicobacter pylori</i> Changed the Life of Surgeons

Abstract

Helicobacter pylori infection has been identified as a pathogenic factor in a number of gastroduodenal diseases, most importantly in gastric and duodenal ulcer disease. This association and the development of H. pylori eradication therapies has had a tremendous influence on the surgical therapy for these disorders. Decades ago, surgery was the therapy of choice for gastric and duodenal ulcers. Now, however, the first line of therapy includes treatment of H. pylori infection, suppression of gastric acid secretion, and protection of gastric mucosal barriers combined with a range of endoscopic procedures. These developments have had a major impact on the indications for surgery in benign gastroduodenal diseases. In addition, advances in our understanding of the pathogenetic mechanisms of H. pylori infection have also changed our views of gastric mucosa-associated lymphoid tissue lymphoma, gastric cancer, and gastroesophageal reflux disease.

A Comprehensive review of abdominal infections

“…Since the development of treatments for H. pylori , its prevalence in the United States has decreased. However, prevalence of gastric and duodenal ulcers has remained the same[62]. …”

1990–2001 U.S. general surgery chief resident gastric surgery operative experience: analysis of paradigm shift

“…The almost ubiquitous use of gastric acid inhibitor therapies (H2 antagonists or proton pump inhibitors) and the therapeutic/prophylactic treatment of gastric H. pylori disease can be credited with the relative disappearance of benign gastric ulcer disease. [1][2][3] Another more recent development has been the rapid penetration of laparoscopic surgical procedures into community practice and subsequently into academic training centers, which has further and significantly reduced the opportunity for general surgery residents to obtain "open" gastric surgical experience. This combination of medical nonoperative management of ulcer disease and the conversion of standard open gastric procedures to laparoscopic procedures has led to the perception that current surgical residents in training do not have adequate exposure to gastric surgery with potential significant impact on their ability to care for patients in need of such services.…”

Trends in the Surgical Management and Outcomes of Complicated Peptic Ulcer Disease

“…Earlier and more effective outpatient treatments for PUD may play roles in the decrease in individuals progressing to more severe complications of the disease. 3 Similarly, the improvement in endoscopic and angiographic capabilities, as well as decreasing affinity for acid-reducing procedures among surgeons, may explain the continued decline in the use of surgical interventions to treat complications of PUD. 6,16 As the management of PUD continues to evolve, efforts must be made to improve the decision-making regarding which patients would receive the most benefit from surgery and what surgical approaches to adopt.…”

“…2 Concurrently, the number of patients that undergo surgical interventions for classical indications of hemorrhage, perforation, or obstruction has decreased. 3,4 Surgical interventions depend on the complications being managed, varying from simple oversew of perforations to ligation of bleeding vessels and/or performance of acid-reducing procedures including vagotomies and antrectomies. 5,6 For patients who cannot take proton-pump inhibitors, those who do not quit smoking, or those who require chronic use of nonsteroidal antiinflammatory drugs, there remains a continued role for acid-reducing procedures.…”