GRAPEVINE, Texas – 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, as some surgeons have advocated, 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. A total of 98% of the operations were laparoscopic. The prevalence of H. pylori by intraoperative mucosal biopsy was 16%. Most important for purposes of this study, the infected patients did not undergo treatment.

A total of 42 patients developed marginal ulcerations an average of 7 months postoperatively, with 69% of cases occurring less than 6 months after surgery. The prevalence of intraoperative H. pylori infection was 9.5% among patients who went on to develop marginal ulcerations and 16.4% in those who did not, strongly suggesting that H. pylori isn’t related to marginal ulcer formation, according to 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 nonsteroidal anti-inflammatory drug (NSAID) use. However, one-third of patients experienced recurrent symptoms upon stopping the PPI, continuing to smoke, or taking NSAIDs.

Ms. Lee observed that, although H. pylori is long established as causally related to 85%-95% of gastric and duodenal ulcers in non–bariatric surgery populations, the microorganism’s role in bariatric surgery patients has not been well studied.

One audience member noted that although eradicating H. pylori may not prevent postoperative marginal ulcerations, perhaps not treating H. pylori–infected bariatric surgery patients might leave them at increased risk of developing a duodenal ulcer postoperatively in a part of the stomach that’s no longer accessible. Ms. Lee said that this study was not designed to address that question.

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德州葡萄藤市(EGMN)——一项大型回顾性研究表明：幽门螺杆菌与内镜下Roux-en-Y胃旁路术后吻合口溃疡的发生无关。

 

在美国代谢及减重外科手术协会的年会上，Hea Jung Lee 宣布：依据她的研究发现，与某些外科医师所信奉的不同，采用药物来消灭幽门螺杆菌从而减低术后吻合口溃疡的风险是毫无理由的。

 

她报道了798例接受Roux-en-Y 胃旁路术的患者，手术均由单个外科医师独立完成。98%的手术在内镜下操作。术中黏膜活检发现幽门螺杆菌的感染率为16%。重要的是，感染患者未进行任何治疗。

 

在术后平均7月，共有42名患者出现吻合口溃疡。其中69%病例在术后不到6月就发生。在随后发生吻合口溃疡的患者中，术中幽门螺杆菌的感染率为9.5%；而在随后未发生吻合口溃疡的患者中，感染率则为6.4%。以上结果强烈提示幽门螺杆菌与吻合口溃疡的发生无关。加州大学欧文分校生物科学院Lee女士报道说。

 

吻合口溃疡的先兆为新发的几周内进展性的胃上部疼痛。 大约62%患者接受内镜检查而确诊，其余则进行假想治疗。所有患者在接受质子泵抑制剂、戒烟和停用非甾体抗炎药(NSAID)治疗后都显效。但是，1/3的患者在停用质子泵抑制剂、重新吸烟或再服NSAID后又出现症状反复。 

 

Lee女士评论道，尽管在非减重外科人群中，幽门螺杆菌早已确定在85%~95%的消化性溃疡中有因果关系，但它在减重外科患者中的角色并未澄清。

 

一位列席成员提到，尽管消灭幽门螺杆菌不能预防术后吻合口溃疡的发生，而对于幽门螺杆菌感染的减重外科患者采取观望不治的态度也会导致封闭胃区发生术后十二指肠溃疡的风险增高。Lee女士解释说该研究并未试图回答该问题。

 

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