The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection

Cemal Ensari

doi:10.4274/atfm.77486

Research Article

Laparoskopik Sleeve Gastrektominin Helicobacter pylori Enfeksiyonuna Etkisi

Year 2018, Volume: 71 Issue: 2, 166 - 169, 10.10.2018

Cemal Ensari

Abstract

Amaç: Helicobacter pylori, birçok benign veya malign hastalığa neden olabilen çok yaygın bir patojendir. H. pylori tarafından kolonize edilen bireylerin çoğunluğu asemptomatiktir. H. pylori, obez hastalarda da yaygın şekilde saptanmıştır. Laparoskopik sleeve gastrektomi (LSG), obezitenin tedavisinde en çok tercih edilen cerrahi seçeneklerden biridir. Bu çalışmada obez hastalarda LSG’nin H. pylori enfeksiyonuna etkisinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Çalışmaya morbid obezite nedeniyle LSG planlanan ve operasyon öncesinde Karbon-14 üre nefes testi (ÜNT) ile H. pylori pozitifliği tesbit edilen toplam 36 hasta dahil edildi. Tüm hastalar postoperatif üçüncü ayda tekrar ÜNT yapılarak değerlendirildi. Hastaların asemptomatik olması sebebiyle ve de oluşabilecek yanlış negatif sonuçların önlenmesi amacıyla hiçbir hastaya hem preoperatif hem de postoperatif dönemde antibiyotik ve proton pompası inhibitörü (PPİ) tedavisi verilmedi.

Bulgular: Hastaların 29’u (%80) kadın, 7’si (%20) erkekti. Ortalama yaş 36 ve ortalama preoperatif vücut kitle indeksi 44 idi. Otuz altı hastanın postoperatif ÜNT değerlendirmesi sonucunda 20 (%55) hastada H. pylori negatif bulundu. Bunlardan 4’ü erkek, 16’sı kadındı. Tüm hastalar H. pylori enfeksiyonu açısından postoperatif dönemde de asemptomatik seyretti.

Sonuç: Hem obezite hem de H. pylori enfeksiyonu genel olarak halk sağlığını etkilemektedir ve ilgili komorbiditeleri önlemek için tedavi gereklidir. Bu çalışmada, LSG öncesi H. pylori enfeksiyonu olan 36 hastanın %55’inin postoperatif üçüncü ayda H. pylori enfeksiyonu açısından negatif olduğunu gördük. Sonuç olarak, LSG’nin H. pylori enfeksiyonunun tedavisinde etkili olduğu düşünülmektedir.

Keywords

Helicobacter pylori, Laparoskopik Sleeve Gastrektomi, Obezite

Ethical Statement

Sağlık Bilimleri Üniversitesi, Antalya Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (no: 2014/249).

Supporting Institution

Project Number

Thanks

References

1. McColl KE. Clinical practice. Helicobacter pylori infection. N Engl J Med 2010;362:1597-1604.
2. Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of helicobacter pylori infection. Helicobacter 2014;19(Suppl 1):1-5.
3. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175-1186.
4. Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, et al. Helicobacter pylori- associated gastritis and primary B-cell gastric lymphoma. Lancet 1991;338:1175-1176.
5. Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med 1994;330:1267-1271.
6. Huang JQ, Sridhar S, Chen Y, et al. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology 1998;114:1169-1179.
7. Forman D, Newell DG, Fullerton F, et al. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ 1991;302:1302-1305.
8. Zhang Y, Hoffmeister M, Weck MN, et al. Helicobacter pylori infection and colorectal cancer risk: evidence from a large population-based case-control study in Germany. Am J Epidemiol 2012;175:441-450.
9. Stolzenberg-Solomon RZ, Blaser MJ, Limburg PJ, et al. Helicobacter pylori seropositivity as a risk factor for pancreatic cancer. J Natl Cancer Inst2001;93:937-941.
10. Pandey M, Shukla M. Helicobacter species are associated with possible increase in risk of hepatobiliary tract cancers. Surg Oncol 2009;18:51-56.
11. Zhou Q, Li L, Ai Y, et al. Diagnostic accuracy of the 14C-urea breath test in Helicobacter pylori infections: a meta-analysis. Wien Klin Wochenschr 2017;129:38-45.
12. 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;51:670-675.
13. Schilling D, Jakobs R, Peitz U, et al. 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.
14. Kopanski Z, Jung A, Wasilewska-Radwanska M, et al. Comparative diagnostic value of the breath test and the urine test with 14C-urea in the detection of the Helicobacter pylori infection. Nucl Med Rev Cent East Eur 2002;5:21- 24.
15. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of helicobacter pylori infection. Clin Microbiol Rev 2006;19:449-490.
16. Lee SY. Future candidates for indications of Helicobacter pylori eradication: do the indications need to be revised? J Gastroenterol Hepatol 2012;27:200- 211.
17. Torres-Landa S, Kannan U, Guajardo I, et al. Surgical management of obesity. Minerva Chir 2018;73:41-54.
18. Carabotti M, D’Ercole C, Iossa A, et al. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol 2014;20:647-653.
19. Uzunismail H. Türkiye’de Helicobacter Pylori Sorunu Gastroenterolojide Klinik Yaklaşım Sempozyum Dizisi. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri 2004;38:33-41.
20. Marti A, Marcos A, Martinez JA. Obesity and immune function relationships. Obes Rev 2001;2:131-140.
21. Genta RM, Lew GM, Graham DY. Changes in the gastric mucosa following eradication of Helicobacter pylori. Mod Pathol 1993;6:281-289.
22. van der Hulst RW, van der Ende A, Dekker FW, et al. Effect of Helicobacter pylori eradication on gastritis in relation to cagA: a prospective 1-year follow-up study. Gastroenterology 1997;113:25-30.
23. Kawai T, Moriyasu F, Tsuchida A. Key Issues Associated with Helicobacter pylori Eradication. Digestion 2016;93:19-23.
24. Sung JJ, Lin SR, Ching JY, et al. Atrophy and intestinal metaplasia one year after cure of H. pylori infection: a prospective, randomized study. Gastroenterology 2000;119:7-14.
25. Ramaswamy A, Lin E, Ramshaw BJ, et al. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery. Arch Surg 2004;139:1094-1096.
26. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 2002;12:634- 638.
27. Mégraud F, Floch P, Labenz J, et al. Diagnostic of Helicobacter pylori infection. Helicobacter 2016;21(Suppl 1):8-13.
28. Keren D, Matter I, Rainis T, et al. Sleeve gastrectomy leads to Helicobacter pylori eradication. Obes Surg 2009;19:751-756.
29. Jackson SJ, Leahy FE, McGowan AA, et al. Delayed gastric emptying in the obese: an assessment using the non-invasive (13)C-octanoic acid breath test. Diabetes Obes Metab 2004;6:264-270.
30. Maddox A, Horowitz M, Wishart J, et al. Gastric and oesophageal emptying in obesity. Scand J Gastroenterol 1989;24:593-598.

The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection

Year 2018, Volume: 71 Issue: 2, 166 - 169, 10.10.2018

Cemal Ensari

Abstract

Objectives: Helicobacter pylori is a very common pathogen that can causes many benign or malign diseases. The majority of individuals colonized by H. pylori are asymptomatic although they have gastritis. H. pylori is also commonly detected in obese patients. Laparoscopic sleeve gastrectomy (LSG) is one of the most preferred surgical option in treatment of obesity. In this study, we aimed to evaluate the effect of LSG on H. pylori infection in obese patients.

Materials and Methods: Totally 36 patients were included who were asymptomatic and had diagnosed with H. pylori infection positive by using Carbon-14 urea breathing test (UBT) before undergoing LSG. All of the patients were evaluated again by using same test in the postoperative third month. To prevent false negative results, and because the patients are asymptomatic, no antibiotics and proton pump inhibitors were given both in preoperative and postoperative period.

Results: Twenty nine patients (80%) were female where 7 (20%) were male. Mean age was 36 and mean preoperative body mass index was Postoperative UBT was negative in 20 of 36 patients (55%). Four of these were male and 16 of these were female. Where 7 (20%) were male. All of the patients maintained asymptomatic postoperatively in terms of H. pylori infection.

Conclusion: Both obesity and H. pylori infection commonly affect public health and should be treated in order to prevent related comorbidities. In this study we have seen that 55% of 36 patients that had H. pylori infection before LSG, became negative in terms of H. pylori infection in postoperative third month. In conclusion, LSG is thought to be effective in the treatment of H. pylori infection.

Keywords

Helicobacter pylori, Laparoscopic Sleeve Gastrectomy, Obesity

Ethical Statement

Supporting Institution

Project Number

Thanks

References

1. McColl KE. Clinical practice. Helicobacter pylori infection. N Engl J Med 2010;362:1597-1604.
2. Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of helicobacter pylori infection. Helicobacter 2014;19(Suppl 1):1-5.
3. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175-1186.
4. Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, et al. Helicobacter pylori- associated gastritis and primary B-cell gastric lymphoma. Lancet 1991;338:1175-1176.
5. Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med 1994;330:1267-1271.
6. Huang JQ, Sridhar S, Chen Y, et al. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology 1998;114:1169-1179.
7. Forman D, Newell DG, Fullerton F, et al. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ 1991;302:1302-1305.
8. Zhang Y, Hoffmeister M, Weck MN, et al. Helicobacter pylori infection and colorectal cancer risk: evidence from a large population-based case-control study in Germany. Am J Epidemiol 2012;175:441-450.
9. Stolzenberg-Solomon RZ, Blaser MJ, Limburg PJ, et al. Helicobacter pylori seropositivity as a risk factor for pancreatic cancer. J Natl Cancer Inst2001;93:937-941.
10. Pandey M, Shukla M. Helicobacter species are associated with possible increase in risk of hepatobiliary tract cancers. Surg Oncol 2009;18:51-56.
11. Zhou Q, Li L, Ai Y, et al. Diagnostic accuracy of the 14C-urea breath test in Helicobacter pylori infections: a meta-analysis. Wien Klin Wochenschr 2017;129:38-45.
12. 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;51:670-675.
13. Schilling D, Jakobs R, Peitz U, et al. 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.
14. Kopanski Z, Jung A, Wasilewska-Radwanska M, et al. Comparative diagnostic value of the breath test and the urine test with 14C-urea in the detection of the Helicobacter pylori infection. Nucl Med Rev Cent East Eur 2002;5:21- 24.
15. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of helicobacter pylori infection. Clin Microbiol Rev 2006;19:449-490.
16. Lee SY. Future candidates for indications of Helicobacter pylori eradication: do the indications need to be revised? J Gastroenterol Hepatol 2012;27:200- 211.
17. Torres-Landa S, Kannan U, Guajardo I, et al. Surgical management of obesity. Minerva Chir 2018;73:41-54.
18. Carabotti M, D’Ercole C, Iossa A, et al. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol 2014;20:647-653.
19. Uzunismail H. Türkiye’de Helicobacter Pylori Sorunu Gastroenterolojide Klinik Yaklaşım Sempozyum Dizisi. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri 2004;38:33-41.
20. Marti A, Marcos A, Martinez JA. Obesity and immune function relationships. Obes Rev 2001;2:131-140.
21. Genta RM, Lew GM, Graham DY. Changes in the gastric mucosa following eradication of Helicobacter pylori. Mod Pathol 1993;6:281-289.
22. van der Hulst RW, van der Ende A, Dekker FW, et al. Effect of Helicobacter pylori eradication on gastritis in relation to cagA: a prospective 1-year follow-up study. Gastroenterology 1997;113:25-30.
23. Kawai T, Moriyasu F, Tsuchida A. Key Issues Associated with Helicobacter pylori Eradication. Digestion 2016;93:19-23.
24. Sung JJ, Lin SR, Ching JY, et al. Atrophy and intestinal metaplasia one year after cure of H. pylori infection: a prospective, randomized study. Gastroenterology 2000;119:7-14.
25. Ramaswamy A, Lin E, Ramshaw BJ, et al. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery. Arch Surg 2004;139:1094-1096.
26. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 2002;12:634- 638.
27. Mégraud F, Floch P, Labenz J, et al. Diagnostic of Helicobacter pylori infection. Helicobacter 2016;21(Suppl 1):8-13.
28. Keren D, Matter I, Rainis T, et al. Sleeve gastrectomy leads to Helicobacter pylori eradication. Obes Surg 2009;19:751-756.
29. Jackson SJ, Leahy FE, McGowan AA, et al. Delayed gastric emptying in the obese: an assessment using the non-invasive (13)C-octanoic acid breath test. Diabetes Obes Metab 2004;6:264-270.
30. Maddox A, Horowitz M, Wishart J, et al. Gastric and oesophageal emptying in obesity. Scand J Gastroenterol 1989;24:593-598.

There are 30 citations in total.

Details

Primary Language	English
Subjects	General Surgery
Journal Section	Articles
Authors	Cemal Ensari 0000-0002-3607-0807
Project Number	-
Publication Date	October 10, 2018
Published in Issue	Year 2018 Volume: 71 Issue: 2

Cite

APA	Ensari, C. (2018). The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(2), 166-169. https://doi.org/10.4274/atfm.77486
AMA	Ensari C. The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection. Ankara Üniversitesi Tıp Fakültesi Mecmuası. October 2018;71(2):166-169. doi:10.4274/atfm.77486
Chicago	Ensari, Cemal. “The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter Pylori Infection”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, no. 2 (October 2018): 166-69. https://doi.org/10.4274/atfm.77486.
EndNote	Ensari C (October 1, 2018) The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 2 166–169.
IEEE	C. Ensari, “The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 2, pp. 166–169, 2018, doi: 10.4274/atfm.77486.
ISNAD	Ensari, Cemal. “The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter Pylori Infection”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/2 (October 2018), 166-169. https://doi.org/10.4274/atfm.77486.
JAMA	Ensari C. The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:166–169.
MLA	Ensari, Cemal. “The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter Pylori Infection”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 2, 2018, pp. 166-9, doi:10.4274/atfm.77486.
Vancouver	Ensari C. The Effect of Laparoscopic Sleeve Gastrectomy on Helicobacter pylori Infection. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(2):166-9.

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