Treating Helicobacter pylori infection after surgery is unnecessary

Editor—We read with interest the systematic review by Danesh and colleagues of the prevalence of infection with Helicobacter pylori among patients after surgery.¹ The overall prevalence of H pylori infection after partial gastrectomy was 50% and after vagotomy was 83%. This finding is consistent with our study in which infection with H pylori was found in 36 out of 73 (49%) patients after gastrectomy and 13 out of 20 (65%) after vagotomy.² However, the authors’ recommendation that these patients should be reviewed and con- sidered for treatment with antibiotics is questionable.

Studies have failed to find an increase in the rate of ulcer relapse after gastric surgery in patients infected with H pylori.²,³,⁴ Other factors such as bile reflux and the use of non-steroidal anti-inflammatory drugs could also account for the recurrence of ulcers. Recurrent ulceration occurs in 10-20% of cases after proximal gastric vagotomy and in less than 5% after subtotal gastrectomy.⁵ There is no evidence to suggest that curing H pylori infection would reduce the incidence of ulcers occurring after gastric surgery. Routine screening for H pylori would subject patients to expensive and unnecessary investigations. Furthermore, indiscriminate use of antibiotics not only wastes resources but also increases the risk of adverse drug reactions and resistance to antibiotics.