Does helicobacter pylori infection impact reflux symptoms after sleeve gastrectomy? A pilot study using patient reported outcome measures (PROMs)

Background: The association between Helicobacter pylori (HP) infection and gastrointestinal symptoms after metabolic and bariatric surgery (MBS) is poorly understood. While sleeve gastrectomy (SG) can exacerbate reflux, there is limited literature evaluating the impact of HP infection on post-SG symptoms. We hypothesize that HP-positive SG patients will experience worse post-operative reflux and eating-related (ER) symptoms. Methods: A retrospective cross-sectional study comparing post-operative PROMs (patient-reported outcome measures) surveys was performed for HP-positive vs. HP-negative SG patients (2/2023 – 12/2024). Pre-operative HP status was determined via esophagogastroduodenoscopy and gastric biopsy testing. PROMs surveys administered were the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) questionnaire and BODY-Q eating modules, assessing ER symptoms, behavior, and distress. Average post-operative survey scores were compared using independent sample t-tests; p-value < 0.05 was deemed statistically significant. Results: Overall, 481 post-operative surveys were completed across 237 patients (80 surveys in the HP-positive cohort, 401 surveys in the HP-negative cohort); 17.7% of patients were HP-positive and 95.2% completed medical treatment. Comparison of post-operative BODY-Q scores revealed that the HP-positive group had a significantly lower ER symptoms score (73.79 ± 12.55 vs. 78.28 ± 12.32; p = 0.003) indicating worse symptoms. Compared to the HP-negative cohort, the HP-positive cohort experienced more frequent bloating (61.3% vs. 47.4%; p = 0.023) and regurgitation (32.5% vs. 18%; p = 0.003). Post-operative GERD-HRQL scores were significantly higher in the HP-positive group (5.76 ± 6.86 vs. 3.68 ± 5.64; p = 0.006) indicating worse reflux. The HP-positive group reported more heartburn after meals (45% vs. 25.9%; p < 0.001). Conclusion: HP-positive patients reported worse post-operative survey results for ER symptoms including more frequent bloating and regurgitation. GERD-HRQL scores in the HP-positive cohort were significantly higher indicating worse reflux-associated symptoms and heartburn after meals. Future studies should explore the impact of HP infection on MBS patients with larger, diverse patient populations and other index procedures.