DO <i>HELICOBACTER PYLORI</i> INFECTION AND ERADICATION THERAPY STATUS INFLUENCE WEIGHT LOSS OUTCOMES AND ENDOSCOPIC FINDINGS AFTER ROUX-EN-Y GASTRIC BYPASS?A HISTORICAL COHORT STUDY

SIA, Gabriela Beatriz; GESTIC, Martinho Antonio; UTRINI, Murillo Pimentel; CHAIM, Felipe David Mendonça; CHAIM, Elinton Adami; CAZZO, Everton

doi:10.1590/S0004-2803.202301000-08

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ORIGINAL ARTICLE • Arq. Gastroenterol. 60 (1) • Jan-Mar 2023 • https://doi.org/10.1590/S0004-2803.202301000-08 copy

DO HELICOBACTER PYLORI INFECTION AND ERADICATION THERAPY STATUS INFLUENCE WEIGHT LOSS OUTCOMES AND ENDOSCOPIC FINDINGS AFTER ROUX-EN-Y GASTRIC BYPASS?A HISTORICAL COHORT STUDY

A infecção por Helicobacter pylori e o resultado de seu tratamento de erradicação influenciam a perda de peso e achados endoscópicos após o bypass gástrico em Y de Roux? Um estudo de coorte histórica

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGLIGHTS

•H. pylori infection status did not influence post-RYGB weight loss.

•Pre-operative H. pylori infection associated with gastritis.

•New-onset H. pylori infection was a protective factor against post-RYGB jejunal erosions.

ABSTRACT

Background:

Currently, there is conflicting evidence linking Helicobacter pylori (HP) infection with weight loss and endoscopic findings after Roux-en-Y gastric bypass (RYGB).

Objective:

To identify correlations between HP infection and its eradication with weight loss and endoscopic findings after RYGB.

Methods:

This is an observational retrospective cohort study based on a prospectively collected database of individuals who underwent RYGB from 2018-2019 at a tertiary university hospital. HP infection and the HP eradication therapy outcomes were correlated with post-operative weight loss and endoscopic findings. Individuals were classified according to the status of HP infection into four groups: no infection; successful eradication; refractory infection; and new-onset infection.

Results:

Of 65 individuals, 87% were female and the mean age was 39±11.2 years. Body mass index significantly decreased from 36.2±3.6 to 26.7±3.3 kg/m² one year after RYGB (P<0.0001). The percentage of total weight loss (%TWL) was 25.9±7.2% and the percentage of excess weight loss was 89.4±31.7%. HP infection prevalence decreased from 55.4% to 27.7% (p=0.001); 33.8% never had HP infection, 38.5% were successfully treated, 16.9% had refractory infection and 10.8 % had new-onset HP infection. %TWL was 27.3±7.5% in individuals who never had HP, 25.4±8.1% in the successfully treated, 25.7±5.2% in those with refractory infection, and 23.4±6.4% in the new-onset HP infection group; there were no significant differences among the four groups (P=0.6). Pre-operative HP infection significantly associated with gastritis (P=0.048). New-onset HP infections significantly associated with a lower frequency of jejunal erosions after surgery (P=0.048).

Conclusion:

No effects of the HP infection on weight loss were identified in individuals undergoing RYGB. A higher prevalence of gastritis was observed in individuals with HP infection before RYGB. New-onset HP infection after RYGB was a protective factor for jejunal erosions.

Keywords:
Helicobacter pylori; gastric bypass; obesity; bariatric surgery; weight loss

	HP infection	No HP infection	Value of P
N	36 (55.4%)	29 (44.6%)	NA
Age (years)	38.1±10.7	39.8±11.6	0.5
Gender	Male: 3 (8.3%)	Male: 5 (17.2%)	0.4
	Female: 33 (91.7%)	Female: 24 (82.8%)
BMI at BS (kg/m²)	36.4±2.7	36±4.2	0.6
Post-op BMI (kg/m²)	26.8±3.7	26.7±2.6	0.9
%TWL	25.5±7.2	26.4±7.4	0.6
%EWL	91.9±37.9	86.2±22.2	0.5
Pre-op gastric ulcer	1 (2.8%)	0	1.0
Pre-op duodenal ulcer	0	0	1.0
Pre-op gastritis	20 (55.6%)	9 (31%)	0.048
Post-op gastritis	9 (25%)	5 (17.2%)	0.6
Post-op jejunal erosions	7 (19.4%)	10 (34.5%)	0.3
Post-op marginal ulcer	0	2 (6.7%)	0.2
Pre-op esophagitis	6 (16.7%)	5 (17.2%)	1.0
Post-op esophagitis	7 (19.4%)	5 (17.2%)	1.0

	HP infection	No HP infection	Value of P
N	18 (27.7%)	47 (72.3%)	NA
Age (years)	42.4±10.1	37.7±11.3	0.1
Gender	Male: 2 (11.1%)	Male: 6 (12.8%)	1.0
	Female: 16 (88.9%)	Female: 41 (87.2%)
BMI at BS (kg/m²)	36.4±3.1	36.1±3.4	0.8
Post-op BMI (kg/m²)	27.4±3.1	26.5±3.3	0.3
%TWL	24.8±5.7	26.3±7.8	0.5
%EWL	83.2±24.4	91.8±34.1	0.3
Pre-op gastric ulcer	0	1 (2.1%)	1.0
Pre-op duodenal ulcer	0	0	1.0
Pre-op gastritis	10 (55.6%)	19 (40.4%)	0.4
Post-op gastritis	5 (27.8%)	9 (19.1%)	0.5
Post-op jejunal erosions	3 (16.7%)	14 (29.8%)	0.3
Post-op marginal ulcer	0	2 (4.3%)	1.0
Pre-op esophagitis	2 (11.1%)	9 (19.1%)	0.7
Post-op esophagitis	3 (16.7%)	9 (19.1%)	1.0

	No HP infection	Successful eradication therapty	Refractory HP infection	New-onset HP infection	Value of P
N	22 (33.8%)	25 (38.5%)	11 (16.9%)	7 (10.8%)	NA
Age (years)	37.6±11.7	37.9±11.4	44.2±11.5	39.7±7.5	0.4
Gender	Male: 4 (18.2%)	Male: 2 (8%)	Male: 1 (9.1%)	Male: 1 (14.3%)	0.7
	Female: 18	Female: 23 (92%)	Female: 10	Female: 6 (85.7%)
	(81.8%)		(90.9%)
BMI at BS (kg/m²)	36.5±2.8	35.7±4.5	36.7±2.8	35.9±2.8	0.8
Post-op BMI (kg/m²)	26.5±2.7	26.5±3.8	27.3±3.7	27.5±2.3	0.8
%TWL	27.3±7.5	25.4±8.1	25.7±5.2	23.4±6.4	0.6
%EWL	88.7±23.2	94.5±41.5	86.1±28.1	78.5±18.4	0.7
Pre-op gastric ulcer	0	1 (4%)	0	0	1.0
Pre-op duodenal ulcer	0	0	0	0	1.0
Pre-op gastritis	6 (27.3%)	13 (52%)	7 (63.6%)	3 (42.9%)	0.2
Post-op gastritis	4 (18.2%)	5 (20%)	4 (36.4%)	1 (14.3%)	0.7
Post-op jejunal erosions	10 (45.5%)	4 (16%)	3 (27.3%)	0	0.048
Post-op marginal ulcer	0	2 (8%)	0	0	0.7
Pre-op esophagitis	4 (18.2%)	5 (25%)	1 (9.1%)	1 (14.3%)	0.9
Post-op esophagitis	4 (18.2%)	5 (25%)	2 (18.2%)	1 (14.3%)	1.0

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
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[1] Corresponding author: Everton Cazzo. E-mail: notrevezzo@yahoo.com.br