Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Obesity (Silver Spring). 2017 Mar;25(3):522-526. doi: 10.1002/oby.21759.
Helicobacter pylori has been implicated as a risk factor for development of marginal ulceration following gastric bypass, although studies have been small and yielded conflicting results. This study sought to determine the relationship between H. pylori infection and development of marginal ulceration following bariatric surgery in a nationwide analysis.
This was a retrospective cohort study using the 2012 Nationwide Inpatient Sample (NIS) database. Discharges with ICD-9-CM code indicating marginal ulceration and a secondary ICD-9-CM code for bariatric surgery were included. Primary outcome was incidence of marginal ulceration. A stepwise forward selection model was used to build the multivariate logistic regression model based on known risk factors. A P value of 0.05 was considered significant.
There were 253,765 patients who met inclusion criteria. Prevalence of marginal ulceration was 3.90%. Of those patients found to have marginal ulceration, 31.20% of patients were H. pylori-positive. Final multivariate regression analysis revealed that H. pylori was the strongest independent predictor of marginal ulceration.
H. pylori is an independent predictor of marginal ulceration using a large national database. Preoperative testing for and eradication of H. pylori prior to bariatric surgery may be an important preventive measure to reduce the incidence of ulcer development.
尽管已有研究表明幽门螺杆菌（H. pylori）是胃旁路术后发生边缘性溃疡的危险因素，但这些研究规模较小，结果相互矛盾。本研究旨在通过全国性分析来确定 H. pylori 感染与减重手术后边缘性溃疡发展之间的关系。
这是一项回顾性队列研究，使用了 2012 年全国住院患者样本（NIS）数据库。纳入了 ICD-9-CM 编码表明边缘性溃疡和二级 ICD-9-CM 编码指示减重手术的出院记录。主要结局是边缘性溃疡的发生率。基于已知的危险因素，采用逐步向前选择模型构建多变量逻辑回归模型。P 值<0.05 被认为具有统计学意义。
共有 253765 名符合纳入标准的患者。边缘性溃疡的患病率为 3.90%。在发现患有边缘性溃疡的患者中，31.20%的患者 H. pylori 阳性。最终的多元回归分析显示，H. pylori 是边缘性溃疡的最强独立预测因子。
使用大型国家数据库，H. pylori 是边缘性溃疡的独立预测因子。在减重手术前进行 H. pylori 的检测和根除可能是减少溃疡发展的重要预防措施。
