Helicobacter pylori (H. pylori) testing: is it necessary in bariatric patients?

Complications after bariatric surgery include gastroesophageal reflux disease (GERD), bleeding, and marginal ulceration. The role of Helicobacter pylori (H pylori) in these outcomes remains unclear.

To evaluate the impact of preoperative H pylori infection on postoperative complications in bariatric patients.

University hospital, United States.

We identified all patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at our institution between 2015 and 2018. Electronic medical records of patients who underwent preoperative testing were reviewed to collect demographics, co-morbidities, and postoperative outcomes, including GERD, bleeding, marginal ulceration, and readmissions. Pathology reports from intraoperative specimens were examined to determine presence of H. Pylori.

Among 735 bariatric patients who underwent preoperative H pylori testing, 179 (24.4%) tested positive for H pylori. All positive patients received treatment prior to surgery. There were no significant differences between H pylori-positive and -negative patients in rates of preoperative GERD, postoperative GERD at 1year, and major bleeding, or readmissions following sleeve gastrectomy or RYGB. In sleeve patients, preoperative positive H pylori status had a significant impact on persistent positive infection on postoperative specimens despite treatment (P = .01). In RYGB patients, preoperative H pylori status had no significant impact on marginal ulcers postoperatively (P = .41).

Preoperative H pylori infection was not associated with postoperative complications, including postoperative GERD, bleeding, readmissions, or marginal ulceration. These findings call into question the routine use of preoperative H pylori testing and treatment in bariatric patients.