P49 – Prevalence of Chronic Gastritis or Helicobacter pylori Infection in Adolescent Sleeve Gastrectomy Patients Does Not Correlate with Symptoms or Surgical Outcomes

Author(s):
Emily Koeck, Miller Hamrick, Faisal Qureshi, Evan Nadler, Children’s National Medical Center

Background: In adult patients undergoing gastric bypass surgery, it is routine practice to perform pre-operative testing for Helicobacter pylori (H. pylori) infection, given the difficulty in accessing the stomach after surgery. Furthermore, there is evidence that infection impairs anastomotic healing and contributes to complications. Long-term, untreated infection increases the risk of gastroesophageal reflux disease (GERD) and gastric cancer. However, there are currently no data for adolescents undergoing bariatric procedures. We noted occasional patients after sleeve gastrectomy with H. pylori detected in their pathologic specimen after surgery, despite very few patients with pre-operative symptoms. We reviewed our experience with our adolescent sleeve gastrectomy cohort to determine the prevalence of H. pylori infection, its predictive factors, and any association with outcomes.

Hypothesis: We hypothesized that H. pylori infection would be associated with pre-operative symptoms and surgical outcomes.

Methods: All patients undergoing sleeve gastrectomy at our hospital were included. We conducted a chart review to determine pre- or post-operative symptoms of GERD or gastritis, as well as any operative complications, including staple-line leak and wound infection. Chart review was also conducted to determine any patient requiring long-term anti-reflux therapy after surgery. Pathology reports were reviewed for H. pylori status and evidence of gastritis.

Results: 61 adolescents had laparoscopic sleeve gastrectomy from January 2010 through November 2013. The prevalence of chronic gastritis was 32.8% (20/61), and 15.0% of those patients had H.pylori (3/20). No patient with H.pylori had pre-operative symptoms, and only 30.0% of patients with pathology-proven gastritis had symptoms (6/20). No complications occurred, and no patient required long-term anti-reflux therapy.

Conclusions: There is a considerable prevalence of gastritis among adolescents undergoing sleeve gastrectomy, but only a small number of these patients had H pylori infection. Neither presence of chronic gastritis nor H. pylori infection correlated with pre- or post-operative symptoms. Thus in the absence of predictive symptomology or any adverse outcome in those who are infected, we advocate for continued routine pathologic evaluation without the need for pre-operative determination.