Helicobacter pylori Eradication Therapy in Obese Patients Undergoing Gastric Bypass Surgery—Fourteen Days Superior to Seven Days?

Cerqueira, Rute; Manso, Maria Conceição; Correia, Manuel R.; Fernandes, Carolina D.; Vilar, Hélder; Nora, Mário; Martins, Paulo

doi:10.1007/s11695-010-0254-4

Cited by 14 publications

(4 citation statements)

References 28 publications

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“…Abdullahi et al employed classic triple therapy (pantoprazole, clarithromycin, and amoxicillin for 7 days) and included overweight and individuals with obesity, while in the study of Laudanno et al they included only patients with obesity undergoing bariatric surgery, they used the quadruple concomitant regimen for 14 days, yielding equivalent ndings. Similar results have been found by Cerqueira et al [21]. Other authors, such as Pellicano R, question this relationship, suggesting a similar H pylori eradication rate in obese and the general population [22].…”

Section: Discussionsupporting

confidence: 84%

Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

Laudanno,

Ahumarán,

Thomé

et al. 2024

Preprint

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Background The global prevalence of obesity is increasing and represents a major public health challenge. However, there is a paucity of data regarding Helicobacter pylori (H pylori) eradication in obese populations. Aim To examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric surgery. Methods A Post hoc analysis was conducted in a cohort of 204 adults patients (129 obese, 75 normal-weight) H. pylori positive included in two multicenter, prospective studies. Patients underwent a 14-day quadruple concomitant treatment, and H pylori eradication was assessed using the 13C-Urea Breath Test. The cohort was stratified according to Body Mass Index (BMI), and statistical analyses were performed using Chi-squared test, Kruskal-Wallis test, and Logistic regression. Results Eradication rates were significantly lower in patients with obesity compared to normal-weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13–0.63, p < 0.01). Furthermore, within the obesity group, the degree of obesity correlated with decreased eradication rates, with Class 3 (BMI 40.0-49.9) and Class 4 (BMI ≥ 50.0) obesity showing the lowest rates (67% and 51%, with an OR 0.28 and 0,15 respectively, P < 0.01). Conclusions Our results indicate that obesity significant influence H pylori eradication especially among severe obesity patients undergoing bariatric surgery. Tailored eradication strategies may be necessary to improve treatment efficacy in this population.

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Section: Discussionsupporting

confidence: 84%

Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

Laudanno,

Ahumarán,

Thomé

et al. 2024

Preprint

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“…Abdullahi et al [149] showed lower rates of Helicobacter pylori eradication using a flat dose of clarithromycin 250 mg and amoxicillin 1 g three times daily with pantoprazole 40 mg twice daily in a population of obese (55%) vs. non-obese patients (85%; P ¼ 0.0059), and suggested that higher doses of antibiotics may be necessary in this group; longer durations also appear more effective [150]. Abdullahi et al [149] showed lower rates of Helicobacter pylori eradication using a flat dose of clarithromycin 250 mg and amoxicillin 1 g three times daily with pantoprazole 40 mg twice daily in a population of obese (55%) vs. non-obese patients (85%; P ¼ 0.0059), and suggested that higher doses of antibiotics may be necessary in this group; longer durations also appear more effective [150].…”

Section: Macrolidesmentioning

confidence: 99%

Dosing of antibiotics in obesity

Janson¹,

Thursky

2012

Current Opinion in Infectious Diseases

138

120

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Obesity causes a number of changes, including an increase in volume of distribution and changes in hepatic metabolism and renal excretion. Several antibiotics have sufficient data to be able to make recommendations, whereas other antibiotics may need to make use of doses at the upper end of the recommended range, or utilize other dose modifications based on pharmacokinetic/pharmacodynamic parameters, in an attempt to reach adequate levels and achieve similar efficacy.

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“…Thus, due to the presence of this bacteria in obese population undergoing Roux-en-Y bypass gastric surgery and the concern that it may exacerbate postoperative foregut symptoms and increase gastric cancer risk, this led the surgeons to adopt a policy of Hp systematic eradication preoperatively. Cerqueira et al suggested that the 14-day triple therapy (proton pump inhibitor, clarithromycin, and amoxicillin) is more effective than 7 days [27]. …”

Section: Discussionmentioning

confidence: 99%

Gastric Adenocarcinoma after Gastric Bypass for Morbid Obesity: A Case Report and Review of the Literature

Ribeiro

Lopes

Neto

et al. 2013

Case Reports in Medicine

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Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.

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Helicobacter pylori Eradication Therapy in Obese Patients Undergoing Gastric Bypass Surgery—Fourteen Days Superior to Seven Days?

Abstract: A 14-days triple therapy is more effective than 7-days triple therapy suggesting this regimen should be the first-line therapy for HP eradication in Portuguese obese patients undergoing bypass gastric surgery.

Cited by 14 publications

References 28 publications

Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

Dosing of antibiotics in obesity

Gastric Adenocarcinoma after Gastric Bypass for Morbid Obesity: A Case Report and Review of the Literature

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