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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

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Abstract

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.

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References

  1. Fried M, Hainer V, Basdevant A, et al. European Guidelines on surgery of severe obesity. Int J Obes. 2007;31:569–77.

    Article  CAS  Google Scholar 

  2. Guidelines ASGE. Role of endoscopy in the bariatric patient. Gastrointest Endosc. 2008;68:1–10.

    Article  Google Scholar 

  3. Cerqueira RM, Manso MC, Correia MR, et al. Helicobacter pylori eradication therapy in obese patients undergoing gastric by-pass surgery—fourteen days superior to seven days? Obes Surg. 2011;21(9):1377–81.

    Article  PubMed  Google Scholar 

  4. Cerqueira RM, Correia M, Fernandes CD, et al. How effective is the quadruple concomitant Helicobacter pylori eradication therapy for obese patients undergoing gastric by-pass surgery? Obes Surg. 2016;26(6):1163–6.

    Article  PubMed  Google Scholar 

  5. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists. Obes Soc Am Soc Metab Bariatric Surg Obes. 2013;21(Suppl 1):S1–27.

    CAS  Google Scholar 

  6. Scheffel O, Daskalaskis M, Weiner RA. Two important criteria for reducing the risk of postoperative ulcers at the gastrojejunostomy site after gastric bypass: patient compliance and type of gastric bypass. Obes Facts. 2011;4(Supp 1):39–41.

    PubMed  Google Scholar 

  7. Eslick GD, Lim LL, Byles JE, et al. Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis. Am J Gastroenterol. 1999;94:2373–9.

    Article  CAS  PubMed  Google Scholar 

  8. Orlando G, Pilone V, Vittiello A, et al. Gastric cancer following bariatric surgery. Surg Laparosc Endosc Percutan Tech. 2014;24:400–5.

    Article  PubMed  Google Scholar 

  9. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: The Maastricht III Consensus Report. Gut. 2007;56:772–81.

    Article  CAS  PubMed  Google Scholar 

  10. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut. 2010;59:1143–53.

    Article  CAS  PubMed  Google Scholar 

  11. Cerqueira RM, Correia MR, Fernandes CD, et al. Cumulative Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass therapy. Obes Surg. 2013;23:145–9.

    Article  PubMed  Google Scholar 

  12. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut. 2012;61:646–64.

    Article  CAS  PubMed  Google Scholar 

  13. Megraud F, Coenen S, Versporten A, et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013;62:34–42.

    Article  CAS  PubMed  Google Scholar 

  14. WHO. The global burden of disease: 2004 update (online), http://www.who.int/healthinfo/global burden disease/2004 report update/en/index/html (2008)

  15. Kearney DJ, Brousal A, et al. Treatment of Helicobacter pylori infection in clinical practice in the United States. Dig Dis Sci. 2000;45:265–71.

    Article  CAS  PubMed  Google Scholar 

  16. Saad RJ, Chey WD. Treatment of Helicobacter pylori infection in 2006. Gastroenterol Hepatol Ann Rev. 2006;1:30–5.

    Google Scholar 

  17. Mégraud F. H. pylori antibiotic resistance: prevalence, importance and advances in testing. Gut. 2004;53:1374–84.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wu DC, Hsu PI, Wu JY, et al. Sequential and concomitant therapy with 4 drugs are equally effective for eradication of H pylori infection. Clin Gastroenterol Hepatol. 2010;8:36–41.

    Article  CAS  PubMed  Google Scholar 

  19. Molina Infante J, Pazos-Pacheco C, Vinagre-Rodriguez G, et al. Non bismuth quadruple concomitant therapy versus standard triple therapy for clarithromycin susceptible H pylori and versus quadruple sequential therapy for clarithromycin resistant H pylori. Helicobacter. 2012;17(4):269–76.

    Article  CAS  PubMed  Google Scholar 

  20. Saad RJ, Schoenfeld P, Kim HM, et al. Levofloxacin based triple therapy versus bismuth based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis. Am J Gastroenterol. 2006;101:488–96.

    Article  CAS  PubMed  Google Scholar 

  21. Gisbert P, Morena F. Systematic review and meta-analysis: levofloxacine based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther 16:1047–1057.

  22. Gisbert JP, Gisbert JL, Marcos S, et al. Empirical rescue therapy after Helicobacter pylori treatment failure: a 10 year single center study of 500 patients. Aliment Pharmacol Ther. 2008;27:346–54.

    Article  CAS  PubMed  Google Scholar 

  23. Rokkas T, Sechopoulos P, Robotis I, et al. Cumulative H. pylori eradication rates in clinical practice by adopting first and second line regimens proposed by the Maastricht III consensus and a third line empirical regimen. Am J Gastroenterol. 2009;104:21–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The author Manso MC acknowledges Fundação para a Ciência e a Tecnologia through grant UID/Multi/04546/2013 and UID/ QUI/50006/2013—POCI/01/0145/FERDER/007265.

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Authors and Affiliations

  1. Gastroenterology, S. Sebastião Hospital, Santa Maria da Feira, Portugal

    Rute M. Cerqueira, M. Correia & H. Vilar

  2. Biostastistics, Faculty of Health Sciences and FP-ENAS University Fernando Pessoa Porto Portugal LAQV-REQUIMTE University of Porto, Porto, Portugal

    M. C. Manso

Authors
  1. Rute M. Cerqueira
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  2. M. Correia
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  3. H. Vilar
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Correspondence to Rute M. Cerqueira.

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Cerqueira, R.M., Correia, M., Vilar, H. et al. 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. OBES SURG 28, 743–747 (2018). https://doi.org/10.1007/s11695-017-2915-z

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