Don't Blame H. pylori for Ulcers After Bypass

GRAPEVINE, TEX. — Helicobacter pylori infection is not involved in marginal ulceration formation after laparoscopic Roux-en-Y gastric bypass, results from a large retrospective study suggest.

Based on these findings, there is no justification to pharmacologically eradicate H. pylori to reduce postoperative risk of marginal ulcerations, Hea Jung Lee said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.

She reported on 798 patients who underwent Roux-en-Y gastric bypass performed by a single surgeon; 98% of the operations were laparoscopic. The prevalence of H. pylori by intraoperative mucosal biopsy was 16%; the infected patients did not undergo treatment.

Marginal ulcerations developed in 42 patients an average of 7 months postoperatively, with 69% of cases occurring within 6 months. The prevalence of intraoperative H. pylori infection was 9.5% in patients who went on to develop marginal ulcerations and 16.4% in those who did not, strongly suggesting that H. pylori is not related to marginal ulcer formation, said Ms. Lee of the school of biosciences at the University of California, Irvine.

The marginal ulcerations were heralded by new-onset upper gastric pain progressing over several weeks. About 62% of affected patients underwent endoscopy to confirm the diagnosis; the rest were treated presumptively. All patients responded to treatment with a proton pump inhibitor and discontinuation of smoking and NSAID use. However, one-third of patients experienced recurrent symptoms upon stopping the PPI, continuing to smoke, or taking NSAIDs.