Cumulative Helicobacter Pylori Eradication Rates by Adopting First- and Second- Line Regimens Proposed by the Maastricht IV Consensus in Obese Patients Undergoing Gastric Bypass Surgery

• Published in: Obesity surgery 2018-03, Vol.28 (3), p.743-747
• Main Authors: Cerqueira, Rute M., Correia, M., Vilar, H., Manso, M. C.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Bacterial infections; Clarithromycin - therapeutic use; Consensus; Drug Therapy, Combination; Endoscopy; Female; Gastric Bypass; Gastrointestinal surgery; Helicobacter Infections - complications; Helicobacter Infections - drug therapy; Helicobacter pylori - isolation & purification; Humans; Levofloxacin - therapeutic use; Male; Medicine; Medicine & Public Health; Middle Aged; Obesity; Obesity, Morbid - microbiology; Obesity, Morbid - surgery; Original Contributions; Prospective Studies; Proton Pump Inhibitors - therapeutic use; Surgery; Surgical outcomes; Surgical techniques; Young Adult
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-017-2915-z

Aims and Methods Our aim was to assess, in obese patients undergoing Roux-en-Y gastric bypass (RYGB) surgery, the cumulative Helicobacter pylori (HP) eradication rates by adopting Maastricht IV guidelines in areas of high clarithromycin resistance rates (CLT)—14 days concomitant first-line therapy with proton-pump inhibitor (PPI) bid, CLT 500 mg bid, metronidazole (MTZ) 500 bid, and amoxicillin (AMX) 1000 mg bid and 14 days second-line therapy with PPI bid, AMX 1000 mg bid and levofloxacin (LVF) 500 mg od. Single-center prospective study was over 4 years. Endoscopy and HP assessment (by histology or C13 urea breath test) were performed at baseline and post-treatment HP status was assessed by C13 urea breath test 4–6 weeks after the end of therapy. Results Seven hundred seventy-seven consecutive HP-positive patients completed concomitant first-line treatment: 636 (81.9%) female, age 41.1 (± 10.2) years. HP was eradicated in 556 patients—71.56% (95% CI: 68.28–74.62%). In the remaining 221 patients, second-line LVF-based regimens eradicated HP in 121 patients—54.75% (95% CI: 48.16–61.18%). These results give 87.13% (95% CI: 84.58–89.31%) ITT and 89.43% (95% CI: 87.03–91.44%) PP cumulative eradication rates. Eradication rates were not significantly different by gender, age, endoscopy findings, and smoking habits. Conclusions By adopting Maastricht IV consensus quadruple concomitant first-line treatment and second-line LVF-based therapy, high cumulative HP eradication rates are achieved but still leaves around 10.6% of obese patients undergoing RYGB in need of the culture and susceptibility testing prior to third-line treatment.