title: Helicobacter pylori infection increases following cholecystectomy.
abstract: Cholecystectomy is frequently linked with duodenogastric reflux and gastritis but its effect on Helicobacter Pylori (H pylori) infection has not been examined. In a prospective study, twenty two patients with documented cholelithiasis underwent upper gastrointestinal endoscopy and biopsy and 24hr dual channel pH monitoring prior to cholecystectomy and again at 3-6 months post-operatively. The antral biopsies were histologically assessed for H pylori and gastritis and awarded an alkaline reflux score. The number of patients with H pylori infection increased from 7 (32%) preoperatively to 15 (68%) post-cholecystectomy (p < 0.05). Cholecystectomy was also associated with an increase in the incidence of gastritis from 7 to 15 (p < 0.05). The increase in H pylori infection rate occurred in association with an increase in the percentage time gastric pH > 4 in the supine position, from 9.6 (2.2) to 22.2 (4.8) percent, (p < 0.01). The median chemical gastritis score, however, did not change significantly following surgery [8(3-11) vs 7(3-11)]. Seven patients remained symptomatic following cholecystectomy all of whom were H pylori positive and had gastritis. H pylori can survive in the alkaline environment which follows cholecystectomy and may contribute to the post-cholecystectomy syndrome.
authors.affiliation: University Department of Histopathology, St. James's Hospital, Dublin, Ireland.
authors.forename: M T
authors.initials: MT
authors.lastname: Caldwell
authors.forename: M
authors.initials: M
authors.lastname: McDermott
authors.forename: S
authors.initials: S
authors.lastname: Jazrawi
authors.forename: G
authors.initials: G
authors.lastname: O'Dowd
authors.forename: P J
authors.initials: PJ
authors.lastname: Byrne
authors.forename: T N
authors.initials: TN
authors.lastname: Walsh
authors.forename: D O
authors.initials: DO
authors.lastname: Hourihane
authors.forename: T P
authors.initials: TP
authors.lastname: Hennessy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002763:Cholecystectomy; D016145:Endoscopy, Digestive System; D005260:Female; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000175:diagnosis* / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D017562:Postcholecystectomy Syndrome / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors