Metabolic Bariatric Surgery, Gastric Cancer, and Helicobacter pylori: A Portuguese Reality?
DOI:
https://doi.org/10.34635/rpc.1136Keywords:
Bariatric Surgery, Helicobacter Infections, Helicobacter pylori, Stomach NeoplasmsAbstract
Obesity is a major healthcare problem, increasingly affecting millions of people and immensely burdening government health budgets worldwide and being responsible for worse life expectancies and unhealthy aging. Metabolic bariatric surgery is a major treatment option for severe obesity, even though very few possible surgical candidates get an operation yearly. It is of paramount importance to raise awareness and promote early referral to multidisciplinary surgical teams. Gastric cancer is one of the most common and high-mortality cancers and is one of 13 obesity-related malignancies. Its association with Helicobacter pylori infection is increasingly recognised through several pathways related to bacterial virulence factors and host-pathogen cross-talk.
This review aims to provide data of Portugal’s national reality regarding Helicobacter infection and gastric cancer in the metabolic bariatric surgery setting and its possible influence on eradication policy and surgical options.
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References
World Obesity Federation. W. O. World Obesity Atlas 2025. Atlanta: WOF;2020.
Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023;33:3-14. doi: 10.1007/s11695- 022- 06332- 1. Erratum in: Obes Surg. 2023;33:15-6. doi: 10.1007/ s11695- 022- 06369- 2.
Liu N, Funk LM. Bariatric Surgery Trends in the U.S.: 1% is the Loneliest Number. Ann Surg. 2020;271:210-1. doi: 10.1097/ SLA.00000000000003714.
International Federation for the Surgery of Obesity and Metabolic Disorders. IFSO Global Registry Report. [accessed Jan 2025] Available at https://www.ifso.com/ifso- registry.php
Lauby- Secretan B, Scoccanti C, Loomis D, Grosse Y, Bianchini F, Straif K, et al. Body Fatness and Cancer- Viewpoint of the IARC Working Group. N Engl J Med. 2016;375:794-8. doi: 10.1056/ NEJMsm1606602.
Liao CY, Schapiro D, Mojdami D, Sheffield KM, Hoog MM, Keni R, et al. Intentional Weight Loss and Associated Cancer Incidence Among People With Overweight or Obesity: A Systematic Literature Review. Endocrinol Diabetes Metab. 2025;8:e70104. doi: 10.1002/ edm2.70104.
Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Pineros M, Znaor A, Bray F. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021. doi: 10.1002/ijc.33588.
Stojanovic B, Zdravkovic N, Petrovic M, Jovanovic I, Stojanovic BS, Dimitrijevic Stojanovic M, et al. A Narrative Review on the Multifaceted Roles of Galectins in Host- Pathogen Interactions During Helicobacter pylori Infection. Int J Mol Sci. 2025;26:7216. doi: 10.3390/ijms26157216.
He Z, Zhou Y, Liu J, Li N, Fan H. The intersection of Helicobacter pylori and gastric cancer: signaling pathways and molecular mechanisms. Front Cell Infect Microbiol. 2025;15:1601501. doi: 10.3389/fcimb.2025.1601501.
Hooi JK, Lai WY, Ng WK, Suen MM, Underwood FE, Tanyingoh D, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta- Analysis. Gastroenterology. 2017;153:420-9. doi: 10.1053/j.gastro.2017.04.022.
Bastos J, Peleteiro B, Barros R, Alves L, Severo M, de Fatima Pina M, et al. Sociodemographic determinants of prevalence and incidence of Helicobacter pylori infection in Portuguese adults. Helicobacter. 2013;18:413-22. doi: 10.1111/hel.12061.
Cortez Nunes F, Mateus TL, Aguiéiras C, Louro R, Peixe B, Calhindro M, et al. Prevalence and Diagnostic Comparison of Helicobacter pylori and Non- Helicobacter pylori Helicobacter Infections in Patients Undergoing Upper Gastrointestinal Endoscopy with Gastric Biopsy in Algarve, Portugal. Microorganisms. 2025;13:1684. doi: 10.3390/ microorganisms13071684.
Antunes R, Oleastro M, Nogueira JP, Lopes Al. Time trend prevalence of helicobacter pylori infection and endoscopic findings in symptomatic children in Portugal: A retrospective study based on three time points in 2009, 2014, and 2019. Helicobacter. 2023;28:e12963. doi: 10.1111/hel.12963.
Lunet N, Peleteiro B, Bastos J, Correia S, Marinho A, Guimarães JT, et al. Child day-care attendance and Helicobacter pylori infection in the Portuguese birth cohort Geração XXI. Eur J Cancer Prev. 2014;23:193-8. doi: 10.1097/CEJ.0b013e328364742a.
Oleastro M, Peleteiro A, Nogueira P, Benoliel J, Santos A, Cabral J, et al. Prevalence and incidence of Helicobacter pylori infection in a healthy pediatric population in the Lisbon area. Helicobacter. 2011;16:363-72. doi: 10.1111/j.1523-5378.2011.00858.x.
Brown WA, Fisher OM, Johari Y, Au J, Stier C, Moore R, et al. International Federation for Surgery for Obesity and Metabolic Disorders Position Statement on the role of Upper Gastrointestinal Endoscopy Before and After Metabolic Bariatric Surgery. Obes Surg. 2025 (in press) doi: 10.1007/s11695-025-08206-8.
Arieira C, Boal Carvalho P, Dias de Castro F, Cotter J. Esophagogastroduodenoscopy Findings in Patients on the Waiting List for Bariatric Surgery. GE Port J Gastroenterol. 2019;26:389-95. doi: 10.1159/000495770.
Sawathanon S, Promchan D, Thongwong M, Wangkulangkul P, Cheewatanakornkul S, Keeratchananont S, et al. Impact of preoperative esophagogastroduodenoscopy in patients undergoing bariatric surgery and development of a model to predict clinically significant abnormal endoscopic findings. Surg Endosc. 2023;37:2202-8. doi: 10.1007/s00464-022-09391-8.
García-Gómez-Heras S, Fernández-Aceñero MJ, González G, Bolaños-Muñoz ML, Franco-Rodríguez R, Paredes-González J, et al. Involvement of Helicobacter pylori in Preoperative Gastric Findings on a Bariatric Population. Int J Environ Res Public Health. 2022;19:9088. doi: 10.3390/ijerph19159088.
Valadares EC, Gestic MA, Utrini MP, Chaim FD, Chaim EA, Cazzo E. PRE-operative screening of Helicobacter pylori in bariatric patients: is histopathological analysis necessary? Arq Gastroenterol. 2022;59:275-80. doi: 10.1590/S0004-2803.2022.0200000-49.
Alimadadi M, Seyedmajidi S, Safamanesh S, Zanganeh E, Hosseini SA, Hajiebrahimi S, et al. Preoperative esophagogastroduodenoscopy findings and effects on laparoscopic Roux-en-Y gastric bypass in area with high prevalence of Helicobacter pylori infection: multi-center experience in Iran. Gastroenterol Hepatol Bed Bench. 2022;15:53-8.
Gómez García de Las Heras S, Galindo Fernández C, Ruiz Tovar J, Fernández-Aceñero MJ. Preoperative management of obese patients undergoing bariatric surgery: Role of endoscopy and Helicobacter eradication. Obes Res Clin Pract. 2021;15:289-90. doi: 10.1016/j. orcp.2021.05.002.
Sen O, Türkçapar AG, Yerdel MA. Screening Esophagogastroduodenoscopy Before Laparoscopic Sleeve Gastrectomy: Results in 819 Patients. J Laparoendosc Adv Surg Tech A. 2021;31:672-5. doi: 10.1089/lap.2020.0541.
Di Palma A, Alhabdan S, Maeda A, Chetty R, Serra S, Quereshy F, et al. Preoperative Helicobacter pylori Screening and Treatment in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg. 2020;30:2816-20. doi: 10.1007/s11695-020-04436-0.
Ozeki KA, Tran SA, Cheung R, Eisenberg D. Preoperative Endoscopic Findings in Veterans Undergoing Bariatric Surgery: Prevalence and Predictors of Barrett's Esophagus. Obes Surg. 2020;30:657-63. doi: 10.1007/s11695-019-04234-3.
Coumes S, Froissart B, Wion N, Reche F, Arvieux C, Borel AL. Prevalence and Factors Associated with Helicobacter Pylori in Patients Undergoing Bariatric Surgery: the SOON Cohort. Obes Surg. 2018;28:3958-64. doi: 10.1007/s11695-018-3440-4.
Wolter S, Dupree A, Miro J, Schroeder C, Jansen MI, Schulze- Zur-Wiesch C, et al. Upper Gastrointestinal Endoscopy prior to Bariatric Surgery-Mandatory or Expendable? An Analysis of 801 Cases. Obes Surg. 2017;27:1938-43. doi: 10.1007/s11695-017-2622-9.
Olmedo L, Calvet X, Gené E, Bordin DS, Voynovan I, Castro-Fernandez M, et al. Evolution of the use, effectiveness and safety of bismuth-containing quadruple therapy for Helicobacter pylori infection between 2013 and 2021: results from the European registry on H. pylori management (Hp-EuReg). Gut. 2024;74:15-25. doi: 10.1136/gutjnl-2024-332804.
Chiappetta S, Stier C, Ghanem OM, Dayyeh BK, Boškoski I, Prager G, et al. Perioperative Interventions to Prevent Gastroesophageal Reflux Disease and Marginal Ulcers After Bariatric Surgery - an International Experts' Survey. Obes Surg. 2023;33:1449-62. doi: 10.1007/s11695-023-06481-x.
Kermansaravi M, Valizadeh R, ShahabiShahmiri S, Zakeri R, Safari S, Eghbali F, et al. Effect of Helicobacter pylori infection on metabolic and bariatric surgical complications: a systematic review and meta-analysis. Updates Surg. 2025;77:2121-34. doi: 10.1007/s13304-025-02151-y.
Briggs H, Nevins EJ, Mushabi A. Histopathological Examination of 404 Sleeve Gastrectomy Specimens at a Large UK Center and Systematic Review of the Published Literature. Obes Surg. 2025;35:263-70. doi: 10.1007/s11695-024-07641-3.
Baillargeon D, Greenblatt M, Cote M, Nadeau M, Couture CY, Hould FS, et al. Prevalence of Helicobacter pylori Infection in Bariatric Surgery Patients. Obes Surg. 2023;33:2132-8. doi: 10.1007/s11695-023-06638-8.
Abu Abeid A, Abeid SA, Nizri E, Kuriansky J, Lahat G, Dayan D. The Association of Helicobacter pylori, Eradication, and Early Complications of Laparoscopic Sleeve Gastrectomy. Obes Surg. 2022;32:1617-23. doi: 10.1007/s11695-022-05996-z.
Nowak K, Di Palma A, Chieu K, Quereshy F, Jackson T, Okrainec A, et al. Histologic and Cost-Benefit Analysis of Laparoscopic Sleeve Gastrectomy Specimens Performed for Morbid Obesity. Arch Pathol Lab Med. 2021;145:365-70. doi: 10.5858/arpa.2020-0084-OA.
Canil AM, Lossa A, Termine P, Caporilli D, Petrozza V, Silecchia G. Histopathology Findings in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg. 2018;28:1760-5. doi: 10.1007/s11695-017-3092-9.
Grant D, Peeler C, Rudasill J, Lazar C, Bodkin A, Criswell SL. The presence of H. pylori in laparoscopic sleeve gastrectomy specimens is associated with increased mucosal thickness, presence of secondary follicles, increased chronic inflammation, and intestinal metaplasia. J Histotechnol. 2024;47:5-12. doi: 10.1080/01478885.2023.2265601.
Laudanno O, Ahumaran G, Thomé M, Gollo P, Gonzalez P, Khoury M. Relationship between obesity severity and Helicobacter pylori eradication in patients undergoing bariatric and metabolic surgery: A post hoc analysis. Obes Surg. 2024;34:3790-5. doi: 10.1007/s11695-024-07505-w.
Parmar C, Pouwels S. Oesophageal and Gastric Cancer After Bariatric Surgery: an Up-to-Date Systematic Scoping Review of Literature of 324 Cases. Obes Surg. 2022;32:3854-62. doi: 10.1007/s11695-022-06304-5.
Shahabi Shahmiri S, Sheikhbahaee E, Davarpanah Jazi A, Zefreh H, Yang W, Valizadeh R, et al. Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass. Obes Surg. 2024;34:2634-49. doi: 10.1007/s11695-024-07240-2.
Kermansaravi M, Kassir R, Shahsavan M, Lainas P, Chiappetta S. Approach to Gastric Intestinal Metaplasia Before Bariatric Surgery. Obes Surg. 2023;33:366-7. doi: 10.1007/s11695-022-06357-6.
Thibeault F, Abbad A, Deffain A, Garneau P, Denis R, Studer AS, et al. Prevalence of gastric intestinal metaplasia and other endoscopic findings and their influence on surgical management for patients seeking bariatric surgery. Surg Obes Relat Dis. 2025;21:1042-47. doi: 10.1016/j.soard.2025.05.011.
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