Patients undergoing weight loss surgery have high rates of H pylori bacteria

CHICAGO – The prevalence of Helicobacter pylori (a type of bacteria associated with gastrointestinal disorders) is high among patients about to undergo weight loss surgery, and treatment to eradicate the bacterial infection before surgery may be beneficial, according to an article in the October issue of The Archives of Surgery, one of the JAMA/Archives journals.

The number of obese and morbidly obese Americans is steadily increasing, according to background information in the article. It is estimated that more than 30 percent of the U.S. population has a body mass index (BMI) over 30 (obese), and five percent of the U.S. population has a BMI over 40, resulting in a increased demand for weight loss surgery, including gastric bypass surgery (surgery that results in food bypassing much of the intestinal tract). Twenty to 50 percent of people living in industrialized countries are infected with H pylori, which is believed to be involved in gastroduodenal ulcer disease (a gastrointestinal tract disease characterized by ulcers in the stomach and upper intestinal tract, or foregut), in addition to gastric cancer, according to the article. The role of H pylori after gastric bypass surgery is unknown.

Archana Ramaswamy, M.D., from Emory University, School of Medicine, Atlanta, and colleagues examined 99 patients between September 2001 and September 2002 as part of an evaluation for weight loss surgery. The patients (16 men and 83 women; average age 40 years; average BMI, 48) underwent routine testing before their weight loss surgeries, including testing for the presence of H pylori.

Before surgery, 24 percent of the patients tested positive for the H pylori infection. Of those who tested positive for H pylori, 48 percent showed significant upper gastrointestinal tract symptoms indicative of H pylori infection after surgery, while similar symptoms were present in 19 percent of the H pylori-negative group. Those with prolonged symptoms who tested positive for the infection were given treatment to eliminate the infection.

The authors write: "The prevalence of H pylori infection in patients undergoing weight loss surgery is high, and a significant proportion of them have postoperative foregut symptoms. Consideration should be given to H pylori treatment in these patients."

(Arch Surg. 2004; 139: 1094-1096. Available post-embargo at archsurg.com.)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelations@jama-archives.org.

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