Published online Jul 28, 2026. doi: 10.3748/wjg.118887
Revised: February 5, 2026
Accepted: March 30, 2026
Published online: July 28, 2026
Processing time: 176 Days and 22.5 Hours
The early postoperative behavior of Helicobacter pylori (H. pylori) after distal gastrectomy (DG) and the host factors influencing early negative conversion remain poorly defined. In this study, we evaluated early postoperative H. pylori dynamics using a standardized stool antigen test (SAT).
To evaluate early postoperative H. pylori dynamics and identified clinicopathological factors associated with early negative conversion.
Among 129 patients who underwent DG for gastric cancer, 53 had active preoperative H. pylori infection, as confirmed by SAT. Postoperative status was reassessed at 3 months, and patients were categorized into the persistent infection (n = 13) or spontaneous negative conversion (n = 40) group. Clinicopathological variables were compared between groups. Multivariable logistic regression was performed, and sensitivity analyses included Firth penalized logistic regression. A post hoc power analysis was conducted to contextualize the sample size.
Early negative conversion on SAT occurred in 75.5% of the patients at 3 months. The early negative conversion group had a higher preoperative American Society of Anesthesiologists (ASA) score than the persistent infection group (2.10 ± 0.67 vs 1.69 ± 0.48; P = 0.024). In the primary multivariable model adjusting for age, body mass index, sex, and postoperative antibiotic use, a higher ASA score was directionally association with early negative conversion (odds ratio = 3.02; 95%CI: 0.91-10.01; P = 0.071). Sensitivity analyses using penalized likelihood and models incorporating serum albumin and hemoglobin produced directionally consistent estimates with wide confidence intervals. Post-hoc power analysis indicated limited statistical power (approximately 0.44) to detect an independent association with the current sample size.
A higher ASA score may be associated with early negative conversion after DG; however, the findings are exploratory and require validation in larger cohorts with longitudinal follow-up to confirm durable eradication.
Core Tip: The early postoperative course of Helicobacter pylori (H. pylori) following distal gastrectomy remains poorly characterized. Using a standardized stool antigen test protocol, this study demonstrated that spontaneous H. pylori clearance occurs in approximately three-quarters of patients within 3 months after surgery. Among evaluated clinicopathological variables, a higher preoperative American Society of Anesthesiologists score was associated with spontaneous clearance, suggesting that host-related factors may influence early postoperative H. pylori dynamics. These findings provide clinically relevant insights that may help optimize postoperative surveillance strategies and inform the timing of eradication therapy after distal gastrectomy.