Spontaneous Elimination of Helicobacter pylori Infection After Bariatric Surgery: Effect of Sleeve Gastrectomy
Yıl 2026,
Cilt: 9 Sayı: 1, 53 - 58, 17.03.2026
Serhat Binici
,
Fırat Aslan
,
Veysel Tahiroğlu
Öz
Aim: This study aimed to evaluate the spontaneous postoperative negativization rate of preoperative Helicobacter pylori (H. pylori) positivity in obese patients undergoing sleeve gastrectomy, without any eradication therapy.
Materials: Twenty-three patients who underwent primary laparoscopic sleeve gastrectomy between 2020 and 2024 were included. Preoperative H. pylori positivity was confirmed by histology, rapid urease test, urea breath test, or stool antigen test. H. pylori status was reassessed at 6 and 12 months postoperatively. Demographic, metabolic, and endoscopic data were recorded. Spontaneous elimination was defined as a negative test confirmed by two different diagnostic methods.
Results: At 12 months, 12 patients were H. pylori-negative, with a total spontaneous elimination rate of 52.2%. Transient negativization at 6 months was 45.0%. The mean gastritis score was 2.1 ± 0.6 in patients who became negative versus 3.0 ± 0.7 in those who remained positive (p = 0.012). HOMA-IR decreased from 4.9 ± 2.3 to 2.6 ± 1.4 (p < 0.001). Significant reductions in total cholesterol, LDL, and triglycerides, and an increase in HDL were observed (p < 0.05). All three patients who developed ulcers remained H. pylori-positive (p = 0.037).
Conclusion: After sleeve gastrectomy, H. pylori may spontaneously disappear in a substantial proportion of patients without eradication therapy, associated with metabolic improvement. Postoperative monitoring and standard test confirmation are important for patient safety and effective antibiotic stewardship.
Etik Beyan
This study was approved by the Sirnak University Non-Interventional Clinical Research Ethics Committee (Decision No: E-94991599-050.99-128821, Date: 26.03.2025).
Kaynakça
-
Hooi JYK, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420-429. Crossref
-
Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-1762. Crossref
-
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Schistosomes, liver flukes and Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1-241. Crossref
-
Afshin A, Reitsma MB, Murray CJL. Health effects of overweight and obesity in 195 countries. N Engl J Med. 2017;377(15):1496-1497. Crossref
-
Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961. Crossref
-
O'Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev. 2020;21(11):e13087. Crossref
-
Castaño-Rodríguez N, Goh KL, Fock KM, Mitchell HM, Kaakoush NO. Dysbiosis of the microbiome in gastric carcinogenesis. Sci Rep. 2017;7(1):15957. Crossref
-
Almazeedi S, Al-Sabah S, Alshammari D, Alqinai S, Al-Mulla A, Al-Murad A, et al. The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):412-415. Crossref
-
Keren D, Matter I, Rainis T, Goldstein O, Stermer E, Lavy A. Sleeve gastrectomy leads to Helicobacter pylori eradication. Obes Surg. 2009;19(6):751-756. Crossref
-
Quercia I, Dutia R, Kotler DP, Belsley S, Laferrère B. Gastrointestinal changes after bariatric surgery. Diabetes Metab. 2014;40(2):87-94. Crossref
Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740-748. Crossref
-
Misra V, Misra S, Dwivedi M, Singh PA, Bhargava V, Gupta SC. A topographic study of Helicobacter pylori density, distribution and associated gastritis. J Gastroenterol Hepatol. 2000;15(7):737-743. Crossref
-
Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(4):848-863. Crossref
-
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-239. Crossref
-
Stefano K, Rosalia A, Chiara B, Federica G, Marco M, Gioacchino L, et al. Non-invasive tests for the diagnosis of helicobacter pylori: state of the art. Acta Biomed. 2018;89(Suppl 8):58.
-
Baryshnikova NV, Ermolenko EI, Leontieva GF, Uspenskiy YP, Suvorov AN. Helicobacter pylori infection and metabolic syndrome. Explor Dig Dis. 2024;3(5):414-427. Crossref
-
Ning L, Liu R, Lou X, Du H, Chen W, Zhang F, et al. Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2019;31(7):735-742. Crossref
-
Chen LW, Chien CY, Yang KJ, Kuo SF, Chen CH, Chien RN. Helicobacter pylori infection increases insulin resistance and metabolic syndrome in residents younger than 50 years old: a community-based study. PLoS One. 2015;10(5):e0128671. Crossref
-
Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and endocrine consequences of bariatric surgery. Front Endocrinol (Lausanne). 2019;10:626. Crossref
-
Vaezi MF, Singh S, Richter JE. Role of acid and duodenogastric reflux in esophageal mucosal injury: a review of animal and human studies. Gastroenterology. 1995;108(6):1897-1907. Crossref
-
Steenackers N, Vanuytsel T, Augustijns P, Tack J, Mertens A, Lannoo M, et al. Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass. Lancet Gastroenterol Hepatol. 2021;6(3):225-237. Crossref
-
Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg. 2023;33(1):3-14. Crossref
-
Dallal RM, Bailey LA. Ulcer disease after gastric bypass surgery. Surg Obes Relat Dis. 2006;2(4):455-459. Crossref
-
Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology. 2018;155(5):1372-1382.e17. Crossref
-
Ford AC, Tsipotis E, Yuan Y, Leontiadis GI, Moayyedi P. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut. 2022;71(10):1967-1975. Crossref
-
Choi Y, Kim N, Yun CY, Choi YJ, Yoon H, Shin CM, et al. Effect of Helicobacter pylori eradication after subtotal gastrectomy on the survival rate of patients with gastric cancer: follow-up for up to 15 years. Gastric Cancer. 2020;23(6):1051-1063. Crossref
-
Byun SY, et al. Characteristics Associated With Spontaneous Helicobacter pylori Clearance After Subtotal Gastrectomy in Patients With Gastric Cancer. Korean J Helicobacter Up Gastrointest Res. 2025;
-
Palmisano S, Campisciano G, Silvestri M, Guerra M, Giuricin M, Casagranda B, et al. Changes in gut microbiota composition after bariatric surgery: a new balance to decode. J Gastrointest Surg. 2020;24(8):1736-1746. Crossref
-
Hamamah S, Hajnal A, Covasa M. Influence of bariatric surgery on gut microbiota composition and its implication on brain and peripheral targets. Nutrients. 2024;16(7):1071. Crossref
-
Liou JM, Malfertheiner P, Hong TC, Cheng HC, Sugano K, Shah S, et al. Screening and eradication of Helicobacter pylori for gastric cancer prevention: Taipei Global Consensus II. Gut. 2025;74(11):1767-1791. Crossref
Schulz C, Liou JM, Alboraie M, Bornschein J, Nunez CC, Coelho LG, et al. Helicobacter pylori antibiotic resistance: a global challenge in search of solutions. Gut. 2025;74(10):1561-1570. Crossref
-
Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-1367. Crossref
Obezite Cerrahisi Sonrası Helicobacter pylori Enfeksiyonunun Spontan Eliminasyonu: Sleeve Gastrektomi Etkisi
Yıl 2026,
Cilt: 9 Sayı: 1, 53 - 58, 17.03.2026
Serhat Binici
,
Fırat Aslan
,
Veysel Tahiroğlu
Öz
Amaç: Bu çalışmanın amacı, sleeve gastrektomi uygulanan obez hastalarda preoperatif Helicobacter pylori pozitifliğinin, herhangi bir eradikasyon tedavisi uygulanmadan postoperatif dönemde spontan olarak negatifleşme oranını değerlendirmektir.
Materyal: 2020–2024 yılları arasında primer laparoskopik sleeve gastrektomi yapılan 23 hasta çalışmaya dahil edildi. Preoperatif H. pylori pozitifliği histoloji, hızlı üreaz testi, üre nefes testi veya dışkı antijen testi ile doğrulandı. Postoperatif 6. ve 12. aylarda H. pylori durumu yeniden değerlendirildi. Demografik, metabolik ve endoskopik veriler kaydedildi. Spontan eliminasyon, iki farklı tanı yöntemiyle doğrulanmış negatif test olarak kabul edildi.
Bulgular: 12. ayda 12 hastada H. pylori negatifleşti, toplam spontan eliminasyon oranı %52.2 olarak bulundu. 6. ayda geçici negatifleşme %45.0 idi. Negatifleşen olgularda ortalama gastrit skoru 2.1 ± 0.6 iken, pozitif kalanlarda 3.0 ± 0.7 idi (p = 0.012). HOMA-IR değeri 4.9 ± 2.3’ten 2.6 ± 1.4’e geriledi (p < 0.001). Total kolesterol, LDL ve trigliseridlerde anlamlı azalma, HDL’de artış gözlendi (p < 0.05). Ülser gelişen 3 olgunun tamamında H. pylori pozitifliği sürdü (p = 0.037).
Sonuç: Sleeve gastrektomi sonrası H. pylori, metabolik iyileşme ile ilişkili olarak, hastaların önemli bir kısmında eradikasyon tedavisi olmadan spontan olarak ortadan kalkabilir. Postoperatif izlem ve standart test doğrulaması, hasta güvenliği ve antibiyotik kullanım etkinliği açısından önemlidir.
Etik Beyan
Bu çalışma, Şırnak Üniversitesi Müdahalesiz Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Karar No: E-94991599-050.99-128821, Tarih: 26.03.2025).
Kaynakça
-
Hooi JYK, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420-429. Crossref
-
Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-1762. Crossref
-
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Schistosomes, liver flukes and Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1-241. Crossref
-
Afshin A, Reitsma MB, Murray CJL. Health effects of overweight and obesity in 195 countries. N Engl J Med. 2017;377(15):1496-1497. Crossref
-
Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961. Crossref
-
O'Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev. 2020;21(11):e13087. Crossref
-
Castaño-Rodríguez N, Goh KL, Fock KM, Mitchell HM, Kaakoush NO. Dysbiosis of the microbiome in gastric carcinogenesis. Sci Rep. 2017;7(1):15957. Crossref
-
Almazeedi S, Al-Sabah S, Alshammari D, Alqinai S, Al-Mulla A, Al-Murad A, et al. The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):412-415. Crossref
-
Keren D, Matter I, Rainis T, Goldstein O, Stermer E, Lavy A. Sleeve gastrectomy leads to Helicobacter pylori eradication. Obes Surg. 2009;19(6):751-756. Crossref
-
Quercia I, Dutia R, Kotler DP, Belsley S, Laferrère B. Gastrointestinal changes after bariatric surgery. Diabetes Metab. 2014;40(2):87-94. Crossref
Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740-748. Crossref
-
Misra V, Misra S, Dwivedi M, Singh PA, Bhargava V, Gupta SC. A topographic study of Helicobacter pylori density, distribution and associated gastritis. J Gastroenterol Hepatol. 2000;15(7):737-743. Crossref
-
Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(4):848-863. Crossref
-
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-239. Crossref
-
Stefano K, Rosalia A, Chiara B, Federica G, Marco M, Gioacchino L, et al. Non-invasive tests for the diagnosis of helicobacter pylori: state of the art. Acta Biomed. 2018;89(Suppl 8):58.
-
Baryshnikova NV, Ermolenko EI, Leontieva GF, Uspenskiy YP, Suvorov AN. Helicobacter pylori infection and metabolic syndrome. Explor Dig Dis. 2024;3(5):414-427. Crossref
-
Ning L, Liu R, Lou X, Du H, Chen W, Zhang F, et al. Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2019;31(7):735-742. Crossref
-
Chen LW, Chien CY, Yang KJ, Kuo SF, Chen CH, Chien RN. Helicobacter pylori infection increases insulin resistance and metabolic syndrome in residents younger than 50 years old: a community-based study. PLoS One. 2015;10(5):e0128671. Crossref
-
Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and endocrine consequences of bariatric surgery. Front Endocrinol (Lausanne). 2019;10:626. Crossref
-
Vaezi MF, Singh S, Richter JE. Role of acid and duodenogastric reflux in esophageal mucosal injury: a review of animal and human studies. Gastroenterology. 1995;108(6):1897-1907. Crossref
-
Steenackers N, Vanuytsel T, Augustijns P, Tack J, Mertens A, Lannoo M, et al. Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass. Lancet Gastroenterol Hepatol. 2021;6(3):225-237. Crossref
-
Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg. 2023;33(1):3-14. Crossref
-
Dallal RM, Bailey LA. Ulcer disease after gastric bypass surgery. Surg Obes Relat Dis. 2006;2(4):455-459. Crossref
-
Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology. 2018;155(5):1372-1382.e17. Crossref
-
Ford AC, Tsipotis E, Yuan Y, Leontiadis GI, Moayyedi P. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut. 2022;71(10):1967-1975. Crossref
-
Choi Y, Kim N, Yun CY, Choi YJ, Yoon H, Shin CM, et al. Effect of Helicobacter pylori eradication after subtotal gastrectomy on the survival rate of patients with gastric cancer: follow-up for up to 15 years. Gastric Cancer. 2020;23(6):1051-1063. Crossref
-
Byun SY, et al. Characteristics Associated With Spontaneous Helicobacter pylori Clearance After Subtotal Gastrectomy in Patients With Gastric Cancer. Korean J Helicobacter Up Gastrointest Res. 2025;
-
Palmisano S, Campisciano G, Silvestri M, Guerra M, Giuricin M, Casagranda B, et al. Changes in gut microbiota composition after bariatric surgery: a new balance to decode. J Gastrointest Surg. 2020;24(8):1736-1746. Crossref
-
Hamamah S, Hajnal A, Covasa M. Influence of bariatric surgery on gut microbiota composition and its implication on brain and peripheral targets. Nutrients. 2024;16(7):1071. Crossref
-
Liou JM, Malfertheiner P, Hong TC, Cheng HC, Sugano K, Shah S, et al. Screening and eradication of Helicobacter pylori for gastric cancer prevention: Taipei Global Consensus II. Gut. 2025;74(11):1767-1791. Crossref
Schulz C, Liou JM, Alboraie M, Bornschein J, Nunez CC, Coelho LG, et al. Helicobacter pylori antibiotic resistance: a global challenge in search of solutions. Gut. 2025;74(10):1561-1570. Crossref
-
Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-1367. Crossref