Inflammatory Disorders Associated With Helicobacter Pylori in the Roux-en-Y Bypass Gastric Pouch

Abstract

Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion:H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection.

Do Helicobacter Pylori Infection and Eradication Therapy Status Influence Weight Loss Outcomes and Endoscopic Findings After Roux-en-Y Gastric Bypass?a Historical Cohort Study

“…As for the prevalence of HP infection in the population with obesity, Gonzalez-Heredia et al (19) reported a prevalence of HP in approximately 17% of individuals with obesity, a frequency much lower than the observed in the present study (55%). Chaves et al (20) described HP infection present in 40.7%, a proportion more comparable to that of the present study. Other studies report a highly variable prevalence of HP infection in pre-operative bariatric patients, with data ranging from 6.9 to 61.3% (21,22) .…”

“…In the current study, the HP eradication treatment led to an eradication rate close to 70%, while in the study carried out by Chaves et al (20) , this same scheme was successful in approximately 80%. Csendes et al (29) found HP infection in 46.8% of patients before BS and in 31.6% afterward, even with the eradication therapy pre-operatively.…”

Helicobacter Pylori Infection and its Relation to Bariatric Surgery Outcome among Slovenian Candidates for Bariatric Surgery

“…On the other hand, alterations of the autonomic system leak visceral sensation in obese patients and those explain asymptomatic pathological situations might be misleading. Several studies also found a correlation with H. pylori and extra gastric manifestations [17], also positive in the population of obese and morbidly obese patients pre and post surgery [18] with clinical pathology of idiopathic trombocitopenic purpura, CagA-positive H. pylori infection in iron-deficiency anemia and ischemic heart disease. Data accumulating from epidemic studies are also positive about the correlation to chronic idiopathic urticaria.…”

“…Clearly, the need of tailored H. pylori eradication regimen for candidates of any bariatric surgery is important to reduce the prevalence of postsurgical lesions. The literature report clear evidence of reduced incidence of visceral perforation and marginal ulcer in patients beeing eradicated of H. pylori prior bariatric surgery to non-eradicated group [18,23]. Data also present higher risk persistency even that the H. pylori eradication protocol was performed preoperatively [24] but to clarify the impact and correlation between H. pylori and a type of postoperative complications well-designed RCTs are obligatory.…”