Helicobacter pylori prevalence and antibiotic resistance in patients undergoing bariatric surgery in Luxembourg: Impact and implications

Background: Helicobacter pylori (H. pylori) infection is a global health concern and may be relevant in candidates for bariatric surgery, yet data on prevalence and antimicrobial resistance in Luxembourg are limited. Materials and Methods: We conducted a retrospective, single-center cohort study including 1,110 patients with obesity evaluated for bariatric surgery at the Centre Hospitalier de Luxembourg between 2010 and 2020. H. pylori status was determined on gastric biopsy and antimicrobial resistance by susceptibility testing. Collected variables included demographics, BMI, eradication outcomes, and postoperative results (BMI loss and complications). A comparative group of 125 patients without obesity with biopsy-proven H. pylori infection was included for descriptive comparison. Results: H. pylori prevalence among bariatric candidates was 29.3%. Among infected patients, 23.3% had strains resistant to at least one antibiotic, and first-line eradication was successful in 86.3%. Infection prevalence differed by nationality, being higher among Portuguese nationals than Luxembourgish patients or those from neighboring countries and was slightly higher in women than in men. Postoperatively, mean BMI reduction was 13.7 kg/m² after sleeve gastrectomy and 14.9 kg/m² after bypass surgery. H. pylori status was not associated with weight-loss outcomes or postoperative complications after adjustment. Conclusion: Approximately one-third of bariatric surgery candidates in Luxembourg have H. pylori infection, with notable antibiotic resistance and variation by nationality and sex. After eradication and adjustment for confounders, H. pylori status was not linked to postoperative weight loss or complication rates.