HELICOBACTER-PYLORI INFECTION INCREASES FOLLOWING CHOLECYSTECTOMY

Cholecystectomy is frequently linked with duodenogastric reflux and ga stritis but its effect on Helicobacter Pylori (H pylori) infection has not been examined. In a prospective study, twenty two patients with d ocumented cholelithiasis underwent upper gastrointestinal endoscopy an d biopsy and 24hr dual channel pH monitoring prior to cholecystectomy and again at 3-6 months post-operatively. The antral biopsies were his tologically assessed for H pylori and gastritis and awarded an alkalin e reflux score. The number of patients with H pylori infection increas ed from 7 (32%) preoperatively to 15 (68%) post-cholecystectomy (p<0.0 5). Cholecystectomy was also associated with an increase in the incide nce of gastritis from 7 to 15 (p<0.05). The increase in H pylori infec tion rate occurred in association with an increase in the percentage t ime gastric pH > 4 in the supine position, from 9.6 (2.2) to 22.2 (4.8 ) percent, (p<0.01). The median chemical gastritis score, however, did not change significantly following surgery [8(3-11) vs 7(3-11)]. Seve n patients remained symptomatic following cholecystectomy all of whom were H pylori positive and had gastritis. H pylori can survive in the alkaline environment which follows cholecystectomy and may contribute to the post-cholecystectomy syndrome.