Avoid common mistakes on your manuscript.
Dear Editor,
Helicobacter pylori is a gram-negative bacteria known to colonise the stomach of some individuals. Its presence within the stomach is associated with peptic ulcer disease and gastric cancer. The prevalence of Helicobacter pylori varies internationally and lower socio-economic status has been associated with increased risk infection [1, 2]. The presence of Helicobacter Pylori has also been associated with increased body mass index independent of other factors [3].
In the context of bariatric surgery, the presence of Helicobacter pylori within the stomach increases risk of marginal ulceration following gastric bypass [4]. Despite this, there are currently no clear recommendations specifically relating to screening for Helicobacter pylori prior to bariatric and metabolic surgery (BMS). Routine utilisation of upper gastrointestinal endoscopy for asymptomatic patients prior to BMS remains controversial and beyond the resources of many healthcare systems [5, 6].
Our unit has screened histology reports from stomach specimens following sleeve gastrectomy and established that 6.2% of specimens (18/291) had presence of Helicobacter pylori identified. Although these patients were treated post-operatively, it is likely that the incidence of Helicobacter pylori presence is similar in patients undergoing gastric bypass who may be at increased risk of potential complications.
Helicobacter pylori stool antigen is a safe, non-invasive and inexpensive alternative of pre-operative screening prior to BMS. Stool antigen testing has the additional benefit of highlighting active infection with Helicobacter pylori rather than serum testing which may be positive for previous episodes of infection [7]. It is likely this form of pre-operative testing could be beneficial on a wider scale and may be something that international and national societies may wish to consider incorporating into specific guidance where routine pre-operative upper gastrointestinal endoscopy is not feasible.
Yours Faithfully.
References
Mezmale L, Coelho LG, Bordin D, et al. Review: Epidemiology of Helicobacter pylori. Helicobacter Helicobacter. 2020;25 Suppl 1:e12734.
Hee Lim S, Kwon J-W, Kim N, et al. Prevalence and risk factors of Helicobacter pylori infection in Korea: nationwide multicenter study over 13 years. BMC Gastroenterol. 2013;13:104.
Suki M, LeiboviciWeissman Y, Boltin D, et al. Helicobacter pylori infection is positively associated with an increased BMI, irrespective of socioeconomic status and other confounders: a cohort study. Eur J Gastroenterol Hepatol. 2018;30(2):143–8.
Rodrigo DC, Jill S, Daniel M, et al. Which factors correlate with marginal ulcer after surgery for obesity? Obes Surg. 2020;30(12):4821–7.
Brown WA, Johari Halim Shah Y, Balalis G, et al. IFSO Position statement on the role of esophago-gastro-duodenal endoscopy prior to and after bariatric and metabolic surgery procedures. Obes Surg. 2020;30(8):3135–53.
Quake SYL, Mohammadi-Zaniani G, Musbahi A, et al. Routine use of esophago-gastro-duodenoscopy (EGD) in bariatric surgery-an international survey of our current practice. Obes Surg. 2022;32(11):3627–34.
Shimoyama T, Oyama T, Matsuzaka M, et al. Comparison of a stool antigen test and serology for the diagnosis of Helicobacter pylori infection in mass survey. Helicobacter. 2009;14(2):87–90.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wiggins, T., Kazmi, T., Khan, Y. et al. Helicobacter Stool Antigen Testing: an Alternative Method for Pre-operative Screening. OBES SURG 33, 374 (2023). https://doi.org/10.1007/s11695-022-06391-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-022-06391-4