The Role of Surgery in Patients with Helicobacter pylori Infection

Since the detection of Helicobacter pylori by Warren and Marshall in 1983 [1], this bacterium has significantly changed our opinion on the pathogenesis of gastritis and peptic ulcer disease. Recent investigations have shown, that chronic type B gastritis is almost exclusively induced by H. pylori infection [2]. The role of H. pylori infection with regard to the development of ulcer disease has still not been completely determined. In duodenal ulcer disease, H. pylori infection of the antral mucosa has been demonstrated in 70%–100% of patients [3], and the bacteria have also been found in the duodenal mucosa of up to 83 % of patients [4]. Generally H. pylori infection within the duodenum is linked with gastric metaplasia in the duodenal mucosa. In the majority of patients, eradication of H. pylori infection leads to a long-lasting healing of duodenal ulcer disease [5–7]. To date, surgical procedures play a minor role in the selective treatment of duodenal ulcer disease, although selective proximal vagotomy has been shown to provide the lowest recurrency rates in comparison with all other single treatment protocols. The rate of ulcer recurrency after selective proximal vagotomy was between 6 % and 12 % 5 years after surgery, when larger patient populations were followed [8–10]. Very few data exist on the effect of surgical treatment on H. pylori infection. There is one contribution in the literature, the only study with a prospective design, showing a reduction in H. pylori colonization following highly selective vagotomy [11].