Should We Test for and Eradicate Helicobacter pylori Before Bariatric Surgery?
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LETTER TO EDITOR/LED REPLY
Should We Test for and Eradicate Helicobacter pylori Before Bariatric Surgery? Sameh Hany Emile 1 Received: 14 October 2020 / Revised: 14 October 2020 / Accepted: 20 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor We thank the authors for their letter commenting on the findings of our study on the relation between Helicobacter pylori (HP) and gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) [1]. We agree with the authors on their conclusion that further large-scale prospective studies are needed to elucidate the link between HP, metabolic syndrome, and the sequence of GERD-Barrett’s esophagus-adenocarcinoma. As we await prospective studies to decipher this contentious relation between HP and GERD, we would emphasize the importance and value of routine screening for HP before and after any bariatric procedure, not just SG, for three main logical reasons. The first reason is that most bariatric procedures involve some degree of gastric resection that varies in type and extent among SG, RYGB, and one-anastomosis gastric bypass (OAGB). Such resection, in addition to other bariatric mechanisms as intestinal bypass, induces changes in the gastrointestinal physiology and homeostasis. Such changes include faster gastric emptying, reduced gastric acid secretion, faster intestinal transit time, and increased release of gut peptides [2]. The impact of these striking physiologic changes on the behavior and progression of HP is not known and was not thoroughly investigated. Since we do not know whether these postoperative changes would render HP more virulent and active or not, it may be better to eradicate these bacteria before proceeding to bariatric surgery. As for the second reason, even if HP was not directly connected to the pathogenesis of GERD, preoperative testing for HP may be imperative before gastric restrictive procedures, namely SG. SG, despite being a very commonly performed procedure
* Sameh Hany Emile [email protected] 1
General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, Dakahlia 35516, Egypt
with good outcomes [3], has been described as a refluxogenic operation. A recent meta-analysis reported the development of de novo GERD in 23% and Barrett’s esophagus in 8% of patients after SG [4]. The development of GERD after SG warrants the prescription of proton pump inhibitors (PPI), usually for long durations. The presence of HP infection along with the longterm acid suppression caused by PPI can hasten the development of atrophic gastritis that can progress eventually to gastric cancer of intestinal type [5]. Thus, the eradication of HP may be deemed necessary to prevent such a catastrophic sequence. Finally, apart from the relation between HP and GERD, as the authors implied in their letter HP can play a role in the development of the metabolic syndrome and fatty liver disease. The observation that bariatric patients who te
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