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.