Skip to main content

Advertisement

SpringerLink
Log in

Sleeve Gastrectomy Leads to Helicobacter pylori Eradication

  • Research Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The role of Helicobacter pylori (HP) in patients scheduled and undergoing laparoscopic sleeve gastrectomy (LSG) has not been previously evaluated.

Methods

Included were obese patients presenting to our institution for LSG over 24 months. All patients had presurgical HP breath test, and the symptomatic ones received triple therapy with symptom follow-up. Post surgery, all excluded stomachs were evaluated for HP, and those that were positive performed a second 13C-urea breath test (UBT) 3 months later.

Results

Forty patients underwent LSG. Male to female sex ratio was 1:3; mean age—42 years; mean weight—122 kg; and mean BMI of 43.4 kg/m2. Presurgical HP was positive in 15 (37.5%) patients (11 symptomatic and four asymptomatic). Only these 11 patients were given HP eradication therapy and all experienced complete subsequent symptom resolution. HP was detected in 17 out of the 40 (42.5%) cases of excluded stomachs. All performed a 13C-UBT 3 months post operation and only three (17.6%) tested positive.

Conclusions

HP infection is frequent in biopsies from patients with previous LSG and the majority of follow-up 13C-UBT were negative. In our small initial sample, we treated only symptomatic patients preoperatively. Routine screening for HP for all LSG patients and/or treatment for all positive ones would subject patients to expensive and unnecessary investigations. We propose that this stomach-reducing, pylorus-preserving surgery might even lead to HP eradication. The clinical implications of HP and this gastrectomy for a non-neoplastic, non-peptic indication deserve further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kopelman PG. Obesity as a medical problem. Nature 2000;404:635–43.

    Article  CAS  Google Scholar 

  2. Maggard MA, Shugarman LR, Suttorp M. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.

    Article  Google Scholar 

  3. Bariatric Surgical Society Takes On New Name, New Mission and New Surgery at http://www.asbs.org/Newsite07/resources/press_release_8202007.pdf published by the American Society for Bariatric Surgery 2007.

  4. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002;347:1175–86.

    Article  CAS  Google Scholar 

  5. Goodwin CS, Mendall M, Northfield TC. Helicobacter pylori infection. Lancet 1997;349:265–9.

    Article  CAS  Google Scholar 

  6. Regan JP, Inabnet WB, Gagner M. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.

    Article  CAS  Google Scholar 

  7. Eshun JK, Black DD, Casteel HB. Comparison of immunohistochemistry and silver stain for the diagnosis of pediatric Helicobacter pylori infection in urease-negative gastric biopsies. Pediatr Dev Pathol. 2001;4:82–8.

    Article  CAS  Google Scholar 

  8. Toulaymat M, Marconi S, Garb J, et al. Endoscopic biopsy pathology of Helicobacter pylori gastritis. Comparison of bacterial detection by immunohistochemistry and Genta stain. Arch Pathol Lab Med. 1999;123:778–81.

    CAS  PubMed  Google Scholar 

  9. Dixson MF, Genta RM, Yardley JH. Classification and grading of gastritis. The update Sydney system. Am J Surg Pathol. 1996;20:1161–81.

    Article  Google Scholar 

  10. Renshaw AA, Rabaza JR, Gonzalez AM. Helicobacter pylori infection in patients undergoing gastric bypass surgery for morbid obesity. Obes Surg. 2001;11:281–3.

    Article  CAS  Google Scholar 

  11. Papavramidis ST, Theocharidis AJ, Zaraboukas TG, et al. Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty. Surg Endosc. 1996;10:825–30.

    Article  CAS  Google Scholar 

  12. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg. 2002;12:634–8.

    Article  Google Scholar 

  13. Buchwald H, Avidor Y, Braunwald E. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.

    Article  CAS  Google Scholar 

  14. Sugerman HJ, Kral JG. Evidence-based medicine reports on obesity surgery: a critique. Int J Obes (Lond). 2005;29:735–45a.

    Article  CAS  Google Scholar 

  15. Christou NV, Sampalis JS, Liberman M. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23, discussion 423–424.

    Article  Google Scholar 

  16. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.

    Article  Google Scholar 

  17. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Working Group on Bariatric Surgery, Executive Summary. May 2002.

  18. Bariatric Surgical Society Takes On New Name, New Mission and New Surgery at http://www.asbs.org/Newsite07/resources/press_release_8202007.pdf published by the American Society for Bariatric Surgery 2007.

  19. Wu MS, Lee WJ, Wang HH, et al. A case–control study of association of Helicobacter pylori infection with morbid obesity in Taiwan. Arch Intern Med. 2005;165:1552–4.

    Article  Google Scholar 

  20. Ramaswamy A, Lin E, Ramshaw BJ, et al. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery for morbid obesity. Arch Surg. 2004;139:1094–6.

    Article  Google Scholar 

  21. Cordeiro F, Ferraz E. H. pylori and gastroplasty in the treatment of morbid obesity. Am J Gastroenterol. 2001;96:605–6.

    Article  CAS  Google Scholar 

  22. Stellato TA, Crouse C, Hallowell PT. Bariatric surgery creating new challenges for the endoscopist. Gastrointest Endosc. 2003;57:86–94.

    Article  Google Scholar 

  23. Leivonen M, Nordling S, Haglund C. The course of Helicobacter pylori infection after partial gastrectomy for peptic ulcer disease. Hepatogastroenterology 1998;45(20):587–91, Mar–Apr.

    CAS  PubMed  Google Scholar 

  24. Koletzko S, Haisch M, Seeboth I. Isotopeselective non-dispersive infrared spectrometer for detection of Helicobacter pylori infection with 13C-urea breath test. Lancet 1995;345:961–2.

    Article  CAS  Google Scholar 

  25. Graham DY, Klein PD, Evans DJ Jr. Campylobacter pylori detected noninvasively by the 13C-urea breath test. Lancet 1987;1:1174–7.

    Article  CAS  Google Scholar 

  26. Cutler AF, Havstad S, Ma CK. Accuracy of invasive and non-invasive tests to diagnose Helicobacter pylori infection. Gastroenterology 1995;109:136–41.

    Article  CAS  Google Scholar 

  27. Nishikawa K, Kawahara H, Yumiba T, et al. Functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy for early gastric cancer. Surgery 2002;131(6):613–24, Jun.

    Article  Google Scholar 

  28. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure. Obes Surg. 2007;17(1):57–62, Jan.

    Article  Google Scholar 

  29. Sheu B-S, Lee S-C, Lin P-W, et al. 13Carbon urea breath test is not as accurate as endoscopy to detect Helicobacter pylori after gastrectomy. Gastrointest Endosc. 2000;51:670–5.

    Article  CAS  Google Scholar 

  30. Schilling D, Jakobs R, Peitz U. Diagnostic accuracy of 13C-urea breath test in the diagnosis of Helicobacter pylori infection in patients with partial gastric resection due to peptic ulcer diseases: a prospective multicenter study. Digestion 2001;63:8–13.

    Article  CAS  Google Scholar 

  31. Kubota K, Shimoyama S, Shimizu N, et al. Studies of 13C-urea breath test for diagnosis of Helicobacter pylori infection in patients after partial gastrectomy. Digestion 2002;65(2):82–6.

    Article  CAS  Google Scholar 

  32. Kubota K, Hiki N, Shimizu N, et al. Utility of [13C] urea breath test for Helicobacter pylori detection in partial gastrectomy patients. Dig Dis Sci. 2003;48(11):2135–8, Nov.

    Article  CAS  Google Scholar 

  33. Togashi A, Matsukura N, Kato S, et al. Simple and accurate (13)C-urea breath test for detection of Helicobacter pylori in the remnant stomach after surgery. J Gastroenterol. 2006;41(2):127–32, Feb.

    Article  Google Scholar 

  34. Lotterer E, Ludtke FE, Tegeler R, et al. The 13Curea breath test-detection of Helicobacter pylori infection in patients with partial gastrectomy. Z Gastroenterol. 1993;31:115–9.

    CAS  PubMed  Google Scholar 

  35. Rino Y, Takanashi Y, Hasuo K, et al. 13C-urea breath test in patients having undergone total gastrectomy. Hepatogastroenterology 2007;54(77):1601–3, Jul–Aug.

    CAS  PubMed  Google Scholar 

  36. Kim ES, Park DK, Hong SH. Helicobacter pylori infection in the remnant stomach after radical subtotal gastrectomy. Korean J Gastroenterol. 2003;42(2):108–14, Aug; Korean.

    Article  Google Scholar 

  37. O’Connor HJ, Wyatt JI, Ward DC, et al. Effect of duodenal ulcer surgery and enterogastric reflux on Campylobacter pyloridis. Lancet 1986;(i):1178–81.

    Article  Google Scholar 

  38. Danesh J, Appleby P, Peto R. How often does surgery for peptic ulceration eradicate Helicobacter pylori? Systematic review of 36 studies. BMJ 1998;316(7133):746–7, Mar 7.

    Article  CAS  Google Scholar 

  39. Papavramidis ST, Theocharidis AJ, Zaraboukas TG. Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty. Surg Endosc. 1996;10:825–30.

    Article  CAS  Google Scholar 

  40. Lee YT, Sung JJ, Choi CL, et al. Ulcer recurrence after gastric surgery: is Helicobacter pylori the culprit. Am J Gastroenterol. 1998;93(6):928–31, Jun.

    Article  CAS  Google Scholar 

  41. Sheu BS, Lee SC, Lin PW, et al. Carbon urea breath test is not as accurate as endoscopy to detect Helicobacter pylori after gastrectomy. Gastrointest Endosc. 2000;51:670–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Unit, Bnai Zion Medical Center, Technion-Institute of Technology, Haifa, Israel

    Dean Keren, Tova Rainis, Omer Goldstein, Edy Stermer & Alexandra Lavy

  2. Surgery Department, Bnai Zion Medical Center, Technion-Institute of Technology, Haifa, Israel

    Ibrahim Matter

  3. Gastroenterology Unit, Bnai Zion Medical Center, 47 Golomb Avenue, Haifa, 33394, Israel

    Dean Keren

Authors
  1. Dean Keren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ibrahim Matter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tova Rainis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omer Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edy Stermer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexandra Lavy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dean Keren.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keren, D., Matter, I., Rainis, T. et al. Sleeve Gastrectomy Leads to Helicobacter pylori Eradication. OBES SURG 19, 751–756 (2009). https://doi.org/10.1007/s11695-008-9694-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-008-9694-5

Keywords

Search

Navigation