Helicobacter pylori Does Not Infect the Gastric Cardia: Myth or Fact?

Abstract

Purpose: Anastomotic ulcers are a non peri-operative complication in post roux-en-y gastric bypass surgery patients. The cause of these ulcers is unclear and many theories have been suggested, including cigarette smoking, gastric acid, partial devascularization at the anastomosis of the roux limb to the gastric pouch and weakening of the gastric mucosa by H. pylori infection. We hypothesize that H. pylori cannot be the cause of anastomotic ulcers in bariatric patients because the organism is not known to infect the gastric cardia. Methods: We enrolled 59 adult patients during the period between April 1, 2009 and March 30, 2010 with normal gastrointestinal anatomy. They underwent upper endoscopy at which time biopsies were obtained from both the gastric cardia and antrum. These biopsy samples were tested for the presence of H. pylori by PyloriTek®, a rapid urease test, and histopathology. Demographic data including age, gender, race and medical insurance status was also collected and analyzed. Results are reported as frequencies and percentages, and are presented in tables. Results: The average age of patients in the study was 60 years. 73% (43) were female and 27% (16) were male; 51% (30) were African American, 46% (27) were Caucasian, 2% (1) were Chinese and 2% (1) were Indian. 49% of the study patients had private insurance; 43% had government funded insurance and 9% had no insurance. Of 59 patients tested, the Pyloritek® test results were available for 57 patients. 25% (15) tested positive for H. pylori in the cardia by Pyloritek® and 71% (42) tested negative. Of the 15 biopsy samples that tested positive in the cardia, 5 (33%) were positive in the cardia only and 10 (67%) were positive in both cardia and antrum. Of 59 patients tested, histopathology results were available for 57 patients. 22% (13) tested positive for H. pylori in the cardia and 75% (44) tested negative. Of the 13 positive test results, 16% (2) tested positive in the cardia only while 11 (84%) were positive in both antrum and cardia. No significant correlation was found between the presence of H. pylori in the gastric cardia or antrum and patients' ages, gender, race or insurance status. We found a strong correlation between the two testing methods (Pyloritek® and histopathological analysis) and between the presence of H. pylori in the antrum and cardia. Conclusion: Our study refutes our null hypothesis that H. pylori does not reside in the gastric cardia. It confirms that H. pylori infects both gastric antrum and cardia. Therefore, because the cardia is used in creating the gastric pouch when performing a roux-en-y gastric bypass, this study supports the theory that H. pylori could be an etiologic factor in patients who develop postoperative anastomotic ulcers.