Helicobacter pylori , Sleeve Gastrectomy, and Gastroesophageal Reflux Disease: Is There a Relation?
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LETTER TO THE EDITOR
Helicobacter pylori, Sleeve Gastrectomy, and Gastroesophageal Reflux Disease: Is There a Relation? Michael Doulberis 1,2,3 & Apostolis Papaefthymiou 2,3,4 & Stergios A. Polyzos 3 & Georgios Kotronis 2 & Dimitra Gialamprinou 2 & Maria Tzitiridou-Chatzopoulou 2,5 & Maria Touloumtzi 2 & Jannis Kountouras 2 Received: 5 July 2020 / Revised: 3 October 2020 / Accepted: 20 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor Emile et al. [1] concluded that bariatric patients (who presumably meet diagnostic criteria for metabolic syndrome (MetS)) with Helicobacter pylori infection (Hp-I) might be vulnerable to gastroesophageal reflux disease (GERD) development, thus implying a potential benefit of Hp eradication. Up to 90% of morbidly obese patients develop metabolic (dysfunction)–associated fatty liver disease (MAFLD); obesity and MAFLD share common pathogenic signaling pathways, such as insulin resistance (IR), a key component of MetS, and obesity per se is considered an independent risk factor for MAFLD [2]. Moreover, an association between MAFLD and GERD has been recently indicated by two independent meta-analyses [3, 4]. Appropriate update data indicate that bariatric patients who underwent several interventions including sleeve gastrectomy should be evaluated for several disorders including GERD, MetS, MAFLD, and Hp status [5]. In this regard, our study group has recently elaborated a relevant study of bariatric patients with MetS, subjected to an elective laparoscopic
* Michael Doulberis [email protected]; [email protected] * Jannis Kountouras [email protected]; [email protected] 1
Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
2
Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 551 33 Thessaloniki, Macedonia, Greece
3
First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Macedonia, Greece
4
Department of Gastroenterology, University Hospital of Larisa, Mezourlo, 41110 Larissa, Greece
5
Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Macedonia, Greece
sleeve gastrectomy [6]; based on both liver and gastric histopathology, we reported significantly higher MetS components as well as histological grade of steatosis, ballooning, and lobular inflammation in Hp-I-positive patients. In another study, we reviewed the current status of the perpetual debate concerning whether Hp, a known class I (definite) carcinogen, possesses or not “protective” properties against GERD and its complications, including Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) [7, 8]. In this respect, the considered contradictory involvement of Hp-I, as an acknowledged risk factor in gastrointestinal tract oncogenesis, such as gastric, duodenal, or/and colorectal cancer, excepting esophagus, is rather paradoxical and inconsistent [9, 10]. One maj
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