Endoscopic Prevalence of Helicobacter Pylori Infection in 611 Patients Undergoing Bariatric Surgery

Desh B Sharma, MD, Piotr Gorecki, MD, Rekha Khurana, MD, Eric Frey, MD, Won Sohn, MD. New York Methodsit Hospital

Background:

Several previous studies have reported a higher prevalence of H. pylori infection in obese patients undergoing bariatric surgery, while others have shown decreased prevalence when compared to the general population. A few studies have suggested a higher incidence of early postoperative foregut symptoms and complications in patients infected with H. pylori. A routine pre-operative screening with the eradication of the organism has been recommended by several authors.

Patients and Methods:

A retrospective review of the prospectively collected bariatric database was performed for patients undergoing bariatric surgery from 2001 till 2009 at a single institution. All patients were operated by a single surgeon and underwent either laparoscopic gastric bypass or adjustable gastric band. All patients underwent preoperative upper endoscopy with gastric biopsy to demonstrate H. pylori histologically by a single gastroenterologist. Analysis of variance (ANOVA) for continuous variables, Pearson chi-square test for categorical variables, and multivariate analysis using logistic regression were performed.

Results:

The 611 patients included 79 males (12.9%) and 532 females (87.1%) with the mean age 39.9 years (10.7 SD) and mean BMI of 47.8 kg/m² (6.4 SD) . The overall prevalence of H. pylori infection was 23.7%. By univariate ANOVA, patients with H. pylori were significantly older (p=0.016). Also, by logistic regression, increasing BMI as a continuous variable was associated with increased prevalence of H. pylori with odds ratio (OR) of 1.03 (p=0.041). Hispanics had a higher prevalence of H. pylori, with an OR of 2.35 (p= 0.023). Prevalence did not differ by sex (p= 0.89).

Conclusion:

Our study demonstrates that the prevalence of H. pylori infection in morbidly obese patients undergoing bariatric surgery is similar to that of the general population in developed nations (< 40%). Our data show an increasing risk of H. pylori infection with higher BMI, increased age, and Hispanic race.

Key Words: Helicobacter pylori – Bariatric surgery – Obesity