ORIGINAL CONTRIBUTIONS Helicobacter pylori, Sleeve Gastrectomy, and Gastroesophageal Reflux Disease; Is there a Relation? Sameh H. Emile 1 & Ayman Elshobaky 1 & Hosam G. Elbanna 1 & Wagdi Elkashef 2 & Mohamed A. Abdel-Razik 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Purpose Sleeve gastrectomy (SG) is an effective bariatric procedure, yet can be associated with complications as gastroesoph- ageal reflux disease (GERD). The present study aimed to investigate the prevalence of Helicobacter pylori (H. pylori) in SG specimens, its relation with GERD, and its impact on postoperative outcomes. Methods All SG specimens received in the pathology laboratory were reviewed. The prevalence of H. pylori in SG specimens was recorded. Patients with H. pylori infection who received triple therapy were compared with patients without H pylori in terms of baseline characteristics, preoperative GERD and its outcome postoperatively, development of new-onset GERD, staple line complications, and weight loss. Results The records of 176 patients were reviewed; 69 (39.2%) were positively tested on H. pylori infection. Patients with H. pylori had higher body mass index (BMI) (RR = 1.51), greater incidence of preoperative GERD (RR = 1.67), and complained more of dyspepsia (RR = 1.87). Eradication of H. pylori was achieved in 67 (97.1%) of 69 patients. Postoperative improvement in GERD symptoms (44.4% Vs 19%, p = 0.036) and dyspepsia (85.7% Vs 51.7%, p = 0.007) was higher in patients with H. pylori with confirmed eradication of infection than patients without H. pylori. Both groups had similar operation time, postoperative BMI, excess weight loss, staple line complications, and new-onset GERD. Conclusions More than one-third of patients with morbid obesity had H. pylori infection. Morbidly obese patients with H. pylori infection may be more prone to develop GERD symptoms; yet after eradication of the infection, they may also experience better improvement in symptoms after SG. Keywords Sleeve gastrectomy . Helicobacter pylori . Gastroesophageal reflux disease . Relation Introduction Sleeve gastrectomy (SG) has become the most frequently per- formed bariatric procedure around the world, and this may be attributed to its satisfactory outcome and high safety profile [1, 2]. However, SG is associated with some complications that include staple line leak and bleeding, persistent vomiting, nu- tritional deficiencies, and gastroesophageal reflux disease (GERD) [2–4]. There is a controversy with regard to the relationship be- tween SG and GERD. While some authors assumed that SG may relieve symptoms of GERD, others suggest that SG may worsen pre-existing GERD and induce new-onset reflux esophagitis [5, 6]. According to a recent meta-analysis, SG increased the se- verity of GERD in 19% of patients with preoperative disease. Moreover, de-novo reflux developed in 23% of patients after SG [4]. Although the mechanism of development of GERD * Sameh H. Emile sameh200@hotmail.com Ayman Elshobaky elshobakyayman@yahoo.com Hosam G. Elbanna hosamelbanna@hotmail.com Wagdi Elkashef wagdi.elkashef@gmail.com Mohamed A. Abdel-Razik drmohamedanwar1981@yahoo.com 1 General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt 2 Pathology Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt Obesity Surgery https://doi.org/10.1007/s11695-020-04648-4