Cumulative Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass surgery

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).

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.

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).

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.