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World J Gastroenterol. May 14, 2014; 20(18): 5274-5282
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5274
Management of Helicobacter pylori infection after gastric surgery
Yang-Sheng Lin, Ming-Jen Chen, Shou-Chuan Shih, Ming-Joug Bair, Ching-Ju Fang, Horng-Yuan Wang
Yang-Sheng Lin, Ming-Jen Chen, Shou-Chuan Shih, Ming-Joug Bair, Horng-Yuan Wang, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan
Yang-Sheng Lin, Ming-Jen Chen, Ching-Ju Fang, Medical Library and Evidence Base Medicine Center, Department of Medical Education, Mackay Memorial Hospital, Taipei 104, Taiwan
Yang-Sheng Lin, Ming-Jen Chen, Shou-Chuan Shih, Horng-Yuan Wang, Mackay Junior College of Medicine, Nursing and Management, Taipei 104, Taiwan
Yang-Sheng Lin, Ming-Jen Chen, Shou-Chuan Shih, Horng-Yuan Wang, Mackay Medical College, New Taipei 252, Taiwan
Ming-Joug Bair, Meiho University, Pingtung 103, Taiwan
Author contributions: Wang HY organized the review article; Chen MJ and Lin YS wrote the article; Shih SC, Wang HY and Bair MJ participated in article reviewing, data analysis, and discussion; Fang CJ conducted the literature review and evidence search; Shih SC supported this work and performed critical reading of the manuscript; Wang HY supported this work and supervised the final editing; all authors read and approved the final manuscript.
Correspondence to: Horng-Yuan Wang, MD, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Chungshan North Road, Taipei 104, Taiwan. hywang@ms2.mmh.org.tw
Telephone: +886-2-25433535 Fax: +886-2-25433642
Received: September 15, 2013
Revised: December 30, 2013
Accepted: January 20, 2014
Published online: May 14, 2014
Abstract

The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori (H. pylori) in patients with previous gastric neoplasia who have undergone gastric surgery. However, the guidelines do not mention optimal timing, eradication regimens, diagnostic tools, and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H. pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy. The purpose of this review is to provide an update which may help physicians to properly manage H. pylori infection in patients who have undergone gastric surgery. This review focuses on (1) the microenvironment change in the stomach after gastrectomy; (2) the phenomenon of spontaneous clearance of H. pylori after gastrectomy; (3) the effects of H. pylori on gastric atrophy and intestinal metaplasia after gastrectomy; (4) incidence and clinical features of ulcers developing after gastrectomy; (5) does eradication of H. pylori reduce the risk of gastric stump cancer in the residual stomach? (6) does eradication of H. pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach? and (7) optimal timing and regimens for H. pylori eradication, diagnostic tools and follow-up strategies for patients undergoing gastrectomy.

Keywords: Helicobacter pylori, Gastrectomy, Gastric stump, Treatment outcome, Stomach neoplasms, Stomach ulcer, Atrophic gastritis, Metaplasia

Core tip: For patients undergoing gastric surgery due to acute complications of peptic ulcer diseases or gastric cancer, this surgical procedure may increase the occurrence of biliary enterogastric reflux and potentially inhibit the growth of Helicobacter pylori (H. pylori) in the stomach. Bile reflux and H. pylori infection appear to have a synergistic effect on cell proliferation in the gastric remnant and may explain the increased risk of cancer after gastrectomy. First-line triple therapy is effective for the eradication of H. pylori in gastrectomized patients. Serology is the only test that is not affected by local changes in the stomach, and could be used to avoid the false-negative results obtained with other tests.