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A potential impact of Helicobacter pylori–related metabolic syndrome on early and long-term outcomes of bariatric surgery

      To the Editor:
      Alqahtani et al
      • Alqahtani A.R.
      • Elahmedi M.
      • Aldarwish A.
      • et al.
      Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study.
      concluded that Saudi Arabian patients with metabolic syndrome–related parameters who undergo bariatric surgery show comparable features regarding the early and 3-year outcomes after endoscopic gastroplasty (EG) and laparoscopic sleeve gastrectomy (LSG).
      Helicobacter pylori (H pylori)–related metabolic syndrome appears to be a predictor of post-LSG and/or post-EG early and long-term outcomes, especially in populations with a high prevalence of H pylori infection, including Saudi Arabians.
      • Kountouras J.
      • Papaefthymiou A.
      • Polyzos S.A.
      • et al.
      Impact of Helicobacter pylori-related metabolic syndrome parameters on arterial hypertension.
      ,
      • Mezmale L.
      • Coelho L.G.
      • Bordin D.
      • et al.
      Review: Epidemiology of Helicobacter pylori.
      Specifically, H pylori infection is very common, with a mean worldwide prevalence of 58%, partly owing to immigrants coming from regions with a high prevalence of H pylori infection.
      • Kountouras J.
      • Papaefthymiou A.
      • Polyzos S.A.
      • et al.
      Impact of Helicobacter pylori-related metabolic syndrome parameters on arterial hypertension.
      Approximately 4.4 billion individuals are infected with H pylori,
      • Kountouras J.
      • Papaefthymiou A.
      • Polyzos S.A.
      • et al.
      Impact of Helicobacter pylori-related metabolic syndrome parameters on arterial hypertension.
      and H pylori infection–related metabolic syndrome is hyperendemic in Saudi Arabia, with a prevalence >80%.
      • Mezmale L.
      • Coelho L.G.
      • Bordin D.
      • et al.
      Review: Epidemiology of Helicobacter pylori.
      In particular, studies from Saudi Arabia have reported an H pylori infection prevalence rate of 88% among morbidly obese patients who underwent esophagogastroduodenoscopy (EGD) before bariatric surgery.
      Moreover, the occurrence of H pylori–related metabolic syndrome may exert an impact on bariatric surgery outcomes, such as on body weight loss and homeostasis of glucose.
      • Gutiérrez-Repiso C.
      • Moreno-Indias I.
      • Martín-Núñez G.M.
      • et al.
      Influence of factors altering gastric microbiota on bariatric surgery metabolic outcomes.
      H pylori infection is considerably linked with postoperative adverse events after LSG,
      • Gómez García de Las Heras S.
      • Galindo Fernández C.
      • Ruiz Tovar J.
      • et al.
      Preoperative management of obese patients undergoing bariatric surgery: role of endoscopy and Helicobacter eradication.
      and preoperative EGD in Saudi obese patients is mandatory to recognize concerns such as H pylori infection that could modify, delay, or postpone the bariatric procedures, including LSG/EG.
      • Zacharakis G.
      • Almasoud A.
      • AlZahrani J.
      • et al.
      Upper gastrointestinal tract involvement in the management of bariatric patients in the Kingdom of Saudi Arabia.
      Likewise, our studies
      • Doulberis M.
      • Pierre N.T.
      • Manzini G.
      • et al.
      Helicobacter pylori-related metabolic parameters and premalignant gastric mucosa histological lesions in Swiss bariatric patients.
      indicate higher rates of premalignant pathologic changes in the gastric mucosa (eg, atrophic gastritis and intestinal metaplasia) and also of metabolic syndrome–related parameters, including insulin resistance and arterial hypertension, in patients with active H pylori infection undergoing LSG. Furthermore, bariatric patients with metabolic syndrome–related H pylori infection might be vulnerable to gastroesophageal reflux disease (GERD) development
      • Emile S.H.
      • Elshobaky A.
      • Elbanna H.G.
      • et al.
      Helicobacter pylori, sleeve gastrectomy, and gastroesophageal reflux disease is there a relation?.
      and H pylori with metabolic syndrome-related GERD or Barrett’s esophagus/esophageal adenocarcinoma sequence in certain subpopulations.
      • Kountouras J.
      • Polyzos S.A.
      • Doulberis M.
      • et al.
      Potential impact of Helicobacter pylori-related metabolic syndrome on upper and lower gastrointestinal tract oncogenesis.
      Therefore, preoperative H pylori eradication may decrease the early and long-term outcomes of LSG and/or EG. H pylori eradication may improve metabolic syndrome–related insulin resistance and arterial hypertension in the early and long term after LSG/EG,
      • Kountouras J.
      • Papaefthymiou A.
      • Polyzos S.A.
      • et al.
      Impact of Helicobacter pylori-related metabolic syndrome parameters on arterial hypertension.
      ,
      • Kountouras J.
      • Papaefthymiou A.
      • Polyzos S.A.
      • et al.
      Letter to the Editor Regarding “The Association of Helicobacter pylori, Eradication, and Early Complications of Laparoscopic Sleeve Gastrectomy” by Abeid et al.
      whereas persistent H pylori infection after LSG or EG might deteriorate such aforementioned metabolic syndrome–related components. Thus, further large-scale prospective controlled studies are warranted.

      Disclosure

      All authors disclosed no financial relationships.

      References

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        Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study.
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        Influence of factors altering gastric microbiota on bariatric surgery metabolic outcomes.
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        Upper gastrointestinal tract involvement in the management of bariatric patients in the Kingdom of Saudi Arabia.
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        Helicobacter pylori-related metabolic parameters and premalignant gastric mucosa histological lesions in Swiss bariatric patients.
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      Linked Article

      • Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score–matched comparative study
        Gastrointestinal EndoscopyVol. 96Issue 1
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          Endoscopic bariatric therapies are less-invasive alternatives to bariatric surgery, and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims to compare weight loss, safety, and comorbidity resolution of ESG compared with laparoscopic sleeve gastrectomy (LSG).
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      • Response
        Gastrointestinal EndoscopyVol. 96Issue 6
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          We thank Kountouras et al1 for their interest in and comment on our study.2 We understand and appreciate the authors’ opinion with regard to Helicobacter pylori–related metabolic syndrome and the fact that H pylori infection is common in patients with obesity. A sample of 227 patients who underwent EGD before bariatric surgery found H pylori in 27% of patiets.3Several studies have suggested that H pylori does not affect laparoscopic sleeve gastrectomy (LSG) perioperative outcomes or postoperative weight loss.
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