Pre-Operative Screening of Helicobacter Pylori in Bariatric Patients: Is Histopathological Analysis Necessary?

Abstract

Background: Helicobacter pylori infection has been reported to lead to post-operative complications after bariatric surgery (BS), especially marginal ulcers. The optimal method for pre-operative screening is yet to be determined. Objective: To analyze the diagnostic accuracy of the endoscopic urease test for the detection of H. pylori in individuals undergoing BS and the main endoscopic and histological changes within this population. Methods: A cross-sectional study was carried out based on a database from medical records of 232 individuals who underwent BS between 2016 and 2019 at a tertiary university hospital. Clinical, anthropometric, and endoscopic data were analyzed. The gold-standard method considered to calculate diagnostic accuracy variables was histopathological examination through hematoxylin-eosin/Giemsa stains. Results: 87.5% of the participants were female; mean age was 38.5±9.5 years and average body mass index was 37.6±3.8 kg/m2. The commonest endoscopic finding was gastritis (50.9%) with a predominance of the mild erosive form (25%). Upon histological examination, 59.1% of the participants had confirmed H. pylori infection. H. pylori infection was associated with higher frequencies of endoscopic duodenitis (23.4% vs 12.6%; P=0.04), histological chronic gastritis (100% vs 56.8%; P<0.0001) and histological acute gastritis (58.4% vs 2.1%; P<0.0001). The urease test had a sensitivity of 79.6% and a specificity of 97.9%, leading to an overall accuracy of 87.1%. Conclusion The endoscopic urease test is highly accurate for pre-operative screening of H. pylori infection in individuals who undergo BS. H. pylori infection was significantly associated with endoscopic (duodenitis) and histopathological (chronic and active gastritis) changes.

Global prevalence of Helicobacter pylori infection among individuals with obesity: A protocol for a systematic review and meta‐analysis

“…Research has demonstrated that eradicating H. pylori before bariatric surgery is associated with improved postoperative outcomes 19 . Nevertheless, there is ongoing controversy regarding the need for confirmatory post‐eradication testing, resulting in some patients undergoing surgery without complete eradication of H. pylori 22,23 . Consequently, understanding the prevalence of H. pylori after eradication, both globally and regionally, could provide valuable insights to surgeons in formulating appropriate strategies.…”

Is Helicobacter pylori infection associated with non-alcoholic fatty liver disease in individuals undergoing bariatric surgery? Cross-sectional study

“…The mechanisms of this association, however, remain unclear and seem to be associated with low-grade inflammation underlying chronic infection by this bacterium and its connection with insulin resistance and imbalances in lipid metabolism. 1 , 2 Meta-analyses carried out by Mantovani et al 3 and Wei et al 4 suggested a significantly increased risk of NAFLD among H. pylori carriers. Nonetheless, these reviews included studies that assessed NAFLD using heterogeneous diagnostic methods, primarily imaging techniques.…”