Helicobacter pylori Effects on Bariatric Surgery Outcomes
Hypersecretion of gastric acid associated with H pylori has been implicated in the formation of ulcers, gastritis, and gastric malignancy.
The Gram-negative bacterium Helicobacter pylori was associated with increased marginal ulceration rates, but otherwise had little impact on bariatric surgery outcomes, according to research published in Obesity Surgery.
Seven studies with 255,435 patients were used for a comprehensive meta-analysis of the effects of H pylori on bariatric surgery outcomes. Three studies were retrospective cohort studies of prospectively collected data and 4 were prospective cohort studies. Open and laparoscopic procedures were assessed in these studies, including sleeve gastrectomy, vertical band gastroplasty, and Roux-en-Y gastric bypass.
No significant differences in demographic characteristics such as, age, body mass index, or diabetes were found between patients with H pylori and those without. Unadjusted results of the meta-analysis compared rates of 5 outcomes in patients with and without H pylori, respectively: bleeding (2.1% vs 0.7%), leak (0.7% vs 0.4%), excess weight loss at 12 months postsurgery (72.3% vs 72.3%), marginal ulceration (31% vs 4%), and hospital length of stay (4.2 days vs 3.2 days).
No statistical significance was found in any outcome, although marginal ulceration could not be studied in the meta-analysis due to a lack of studies assessing this condition. In the single study investigating marginal ulceration, H pylori infection was the largest independent predictor, with a tenfold increase in the development of ulcers compared with patients without H pylori.
Further study is required to assess the full impact of H pylori infection on bariatric surgery outcomes, as this review, although the most comprehensive to date, was limited by the lack of data and studies focused on this topic.
Mocanu V, Dang JT, Switzer N, et al. The effect of Helicobacter pylori on postoperative outcomes in patients undergoing bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2018;28(2):567-573.