HELICOBACTER PYLORI AND GALLSTONE DISEASE: DOES OPTIMIZING PREOPERATIVE DIAGNOSIS AVOID UNNECESSARY SURGICAL INTERVENTION IN PATIENTS REFERRED FOR SYMPTOMATIC GALLSTONE DISEASE?
Sonam Kapadia*, Amy H. Kaji, Junko Ozao-Choy, Kathryn Chen
Harbor UCLA Medical Center, Torrance, CA
Background/Objective: The incidence of Helicobacter pylori gastritis in the general United States population is low; however, in Los Angeles County, there is a higher prevalence of H. pylori colonization. The aim of our study was to investigate the role of concomitant gastric H. pylori infection as a confounding factor for symptoms precipitating surgical referral for gallstone disease and its impact on ultimate clinical outcomes.
Methods: A retrospective review of patients referred to a single surgery clinic in LA county for suspected gallstone disease from 2014-2018 was performed. Demographics, clinical factors, and final outcomes were collected and analyzed.
Results: In this time period, 746 patients were evaluated for gallstone disease. With a median age of 43 years and median BMI of 30, the cohort was comprised of 94% (n=698) Hispanic and 85% (n=634) female patients. Twenty-six percent of patients (n=193) were suspected of having symptoms of gastritis rather than biliary colic, and were tested for H. pylori. Of these, 39% (n=76) were H. pylori positive. Fifty-eight percent of the H. pylori positive patients (n=44, 5.9% of total cohort) experienced partial or complete symptom resolution with triple therapy, and 36% (n=27, 3.6% of total cohort) avoided unnecessary surgical intervention. Of the 553 patients who were offered cholecystectomy upfront, 8% (n=44) had unresolved pain symptoms postoperatively of whom 45% (n=20) were H. pylori positive and 60% (n=12) of those treated had symptom resolution after H. pylori triple therapy. When compared to those who were tested preoperatively, the odds ratio for H. pylori infection postoperatively was 2.2 (95% CI 1.1-4.5, p=0.02).
Conclusion: In this county, Hispanic pre-dominant patient population, 10% of all surgical referrals for gallstone disease tested for H. pylori were found to have concomitant H. pylori infection. Unresolved postoperative pain was a significant predictor of H. pylori positivity. Distinguishing the symptomatology of atypical and dyspepsia symptoms of H. pylori infection from true biliary colic is essential. Accurate diagnosis and management of H. pylori infection with appropriate medical therapy among patients referred to surgery for presumptive biliary disease avoids unnecessary surgery along with its associated risks and costs.
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