Cumulative Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass surgery.
BACKGROUND
Our aim was to assess, in obese patients undergoing Roux-en Y gastric bypass surgery, the cumulative Helicobacter pylori (HP) eradication rates in two consecutive time spans (2006-2008 and 2009-2010).


METHODS
The study adopted a 14-day clarithromycin-based triple therapy in first-line treatment as proposed by the Maastricht III consensus-proton pump inhibitor bid, clarithromycin 500 mg bid and amoxicillin 1,000 mg bid-and a 14-day second-line levofloxacin-based empirical regimen-proton pump inhibitor bid, amoxicillin 1,000 mg bid and levofloxacin 500 mg od.


RESULTS
In 2006-2008, 253 patients received first-line therapy. HP was eradicated in 200 patients and 14 patients withdrew (intention to treat (ITT) = 79.1 %; per protocol (PP) = 83.7 %). In the remaining 39 patients, HP was eradicated in 22 patients and 8 patients withdrew (ITT = 56.4 % and PP = 71.0 %). Thus, out of 253 patients, HP was eradicated in 222 patients, 22 patients withdrew and 9 remained positive. In 2009-2010, 437 patients received first-line therapy. HP was eradicated in 256 patients and 30 patients withdrew (ITT = 58.6 %; PP = 62.9 %). In the remaining 151 patients, HP was eradicated in 80 and 6 patients withdrew (ITT = 53.0 % and PP = 55.1 %). These results give cumulative eradication rates of 87.7 % ITT and 96.1 % PP (2006-2008) and of 76.9 % ITT and 83.8 % PP (2009-2010).


CONCLUSIONS
Cumulative HP eradication rates have fallen during 2006-2010 due to the fall of first-line eradication therapy rate, which was around 20 %. Therefore, the first-line clarithromycin-based Maastricht III consensus eradication is no longer effective in bariatric patients indicating the need to test new regimens.
Service of Gastroenterology, S. Sebastião Hospital, R Dr. Cândido Pinho, 4520-271, Santa Maria da Feira, Portugal. rute.cerqueira@chedv.min-saude.pt
Rute M
RM
Cerqueira
Manuel R
MR
Correia
Carolina D
CD
Fernandes
Hélder
H
Vilar
M Conceição
MC
Manso
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000472:pathogenicity*; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D015242:Ofloxacin / Q000008:administration & dosage; D011174:Portugal / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D017211:Treatment Failure; D055815:Young Adult
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D017291:Clarithromycin