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World J Gastroenterol. Jan 21, 2014; 20(3): 647-653
Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.647
Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery
Marilia Carabotti, Chiara D’Ercole, Angelo Iossa, Enrico Corazziari, Gianfranco Silecchia, Carola Severi
Marilia Carabotti, Chiara D’Ercole, Enrico Corazziari, Carola Severi, Department of Internal Medicine and Medical Specialties, University Sapienza, 00161 Roma, Italy
Angelo Iossa, Gianfranco Silecchia, Department of Medical Surgical Sciences and Biotechnology, University Sapienza, 04100 Latina, Italy
Author contributions: Carabotti M and Severi C contributed to study conception and design, and acquisition and interpretation of data, and wrote the manuscript; D’Ercole C and Iossa A contributed to the bibliographic research; Silecchia G and Corazziari E revised the manuscript critically for important intellectual content.
Supported by University Sapienza 000324_2012_AR_SEVERI-SEVERI-PROGETTO RICERCA SAPIENZA 2012
Correspondence to: Carola Severi, MD PhD, Assistant Professor, Department of Internal Medicine and Medical Specialties, University Sapienza, Viale del Policlinico, 00161 Roma, Italy.
Telephone: +39-6-49978384 Fax: +39-6-4463737
Received: October 14, 2013
Revised: November 12, 2013
Accepted: November 28, 2013
Published online: January 21, 2014

The present review summarizes the prevalence and active clinical problems in obese patients with Helicobacter pylori (H. pylori) infection, as well as the outcomes after bariatric surgery in this patient population. The involvement of H. pylori in the pathophysiology of obesity is still debated. It may be that the infection is protective against obesity, because of the gastritis-induced decrease in production and secretion of the orexigenic hormone ghrelin. However, recent epidemiological studies have failed to show an association between H. pylori infection and reduced body mass index. H. pylori infection might represent a limiting factor in the access to bariatric bypass surgery, even if high-quality evidence indicating the advantages of preoperative H. pylori screening and eradication is lacking. The clinical management of infection is complicated by the lower eradication rates with standard therapeutic regimens reported in obese patients than in the normal-weight population. Prospective clinical studies to ameliorate both H. pylori eradication rates and control the clinical outcomes of H. pylori infection after different bariatric procedures are warranted.

Keywords: Helicobacter pylori, Obesity, Bariatric surgery, Ghrelin, Antibiotic resistance

Core tip: This review deals with the active clinical problems related to Helicobacter pylori (H. pylori) infection in obese patients. Even if still controversial, the infection might represent a confounding and limiting factor in bariatric surgery, due to the high incidence of postoperative foregut symptoms and/or lesions in non-eradicated patients. The controversies on preoperative H. pylori screening are highlighted, as well as those related to its clinical management, which is complicated by the low eradication rates in obesity. Finally, a revision of studies on the possible correlation between H. pylori and body mass index and its possible protective role in development of obesity is included.