Spontaneous Helicobacter pylori Clearance After Subtotal Gastrectomy: A Shift in Postoperative Strategy

Helicobacter pylori infection is recognized as a major risk factor for gastric cancer, driving chronic gastritis and precancerous changes such as atrophy and intestinal metaplasia. While eradicating H. pylori is widely recommended in high-risk populations, clear guidelines for eradication treatment following gastric cancer surgery remain elusive. The physiological changes in the remnant stomach after surgery complicate the management of H. pylori status. The study, “Characteristics Associated With Spontaneous Helicobacter pylori Clearance After Subtotal Gastrectomy in Patients With Gastric Cancer,” provides crucial data regarding the effect of gastric cancer surgery on H. pylori status and histological factors [1]. In this prospective study, a remarkably high spontaneous clearance rate of H. pylori (81.3%, or 13 out of 16 patients) was observed. Significantly, the majority of patients (50.0%) achieved negative conversion within the first 6 months postoperatively. The findings also shed light on the accompanying histological changes. Histological factors such as neutrophils and mononuclear cells, which are associated with chronic inflammation, generally decreased over time after surgery. While previous studies reported spontaneous clearance rates around 40% [2,3], the significantly higher rate in this study highlights the profound impact of subtotal gastrectomy on H. pylori colonization. However, this remarkably high rate warrants careful interpretation. The study’s focus on Billroth I reconstruction may contribute to this difference, as bile reflux patterns differ from other reconstruction methods. Additionally, the small sample size and exploratory study design without multiple comparison corrections suggest these findings require validation in larger studies. Given the high rate of spontaneous clearance, the study concludes that H. pylori status should be reevaluated after surgery to confirm the presence of H. pylori. An important consideration is that post-gastrectomy anatomical changes may affect diagnostic accuracy. The combination of rapid urease test and histopathology used in this study is appropriate, as altered gastric pH and bacterial distribution patterns in the remnant stomach may reduce the sensitivity of individual tests. This suggests that postoperative eradication therapy may not be necessary for all patients who underwent subtotal gastrectomy and were previously H. pylori-positive. The study, however, acknowledges limitations, including a small sample size, single-center design, and relatively short follow-up. The findings are exploratory in nature and should be interpreted with caution. Geographic variations in H. pylori strain characteristics and host genetic factors may also influence these results. Future studies with larger sample sizes and statistical models incorporating corrections for multiple testing are necessary to validate these preliminary observations and guide clinical practice.