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Bismuth-Based Therapy: The New Therapy for Obese Patients Undergoing Gastric Bypass Surgery?

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A Correction to this article was published on 04 March 2024

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Abstract

Aims

Our aim was to assess, in obese patients undergoing Roux-en Y gastric bypass surgery, the bismuth quadruple therapy (BQT) eradication rates at the first-line Helicobacter pylori (Hp) treatment as proposed by the Maastricht V/Florence consensus in areas with high clarithromycin (CLT) resistance rates–10 days proton pump inhibitor bid and three-in-one single capsule bismuth therapy containing bismuth, metronidazole, and tetracycline, marketed as Pylera four times a day.

Methods

This is a single-center prospective study over a 3-year period. Endoscopy and Hp assessment by histology was performed at baseline, and posttreatment Hp status was assessed by C13 urea breath test 4–6 weeks after the end of therapy. Data analysis was performed using the IBM® SPSS® Statistics 28.0 (IBM Corp. 2021, Armonk, NY) using mostly nonparametric comparisons (α = 0.05).

Results

The study cohort consisted of 598 adult obese Hp-positive patients [476, 78.6% female, age 43.2 (± 10.4) years] consecutively scheduled for Hp eradication therapy. Hp was eradicated in 500 patients [83.6.3% (95% CI: 80.4%–86.5%)], and the eradication was independent of gender, age, endoscopic diagnosis, and smoking status (p > 0.05).

Conclusion

Ten days of BQT did achieve Maastricht V/Florence recommended first-line eradication rates (at least 80%) in obese Portuguese patients undergoing Roux-en Y gastric bypass, being by now the most reliable choice for Hp eradication.

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Data Availability

The data that support the findings of this study are available from the corresponding author, (Cerqueira RM), upon reasonable request.

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Authors and Affiliations

  1. Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal

    Cerqueira Rute Maria, Correia Manuel Rodriguez, Pita Ines, Vilar Helder, Sousa Mafalda & Veloso Ricardo

  2. Biostastistics, Faculty of Health Sciences, FP-I3ID (Instituto de Investigação, Inovação E Desenvolvimento), University Fernando Pessoa, Portugal & LAQV-REQUIMTE-UP, Porto, Portugal

    Manso M. Conceição

Authors
  1. Cerqueira Rute Maria
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  2. Correia Manuel Rodriguez
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  3. Pita Ines
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  4. Vilar Helder
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  5. Sousa Mafalda
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  6. Veloso Ricardo
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  7. Manso M. Conceição
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Corresponding author

Correspondence to Cerqueira Rute Maria.

Ethics declarations

Ethics Approval

Ethical Principles for Medical Research Involving Human Subjects is not applicable to our paper. This treatment is the Hp eradication standard of care. As the treatment was not prescribed as part of a clinical research trial, there was no need for study approval of the Hospital’s Ethics Committee (this is a real-world, nonintervention study with a standard of care therapy)—see “Patients and Methods.”

Conflict of Interest

The authors declare no competing interests.

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Reprint requests are addressed to Rute Cerqueira, who is the guarantor of the article.

Key Points

There is a need for a Helicobacter pylori eradication protocol prior to bariatric surgery.

Maastricht V/Florence consensus recommends the first-line bismuth quadruple therapy in countries with high prevalence of clarithromycin resistance.

Helicobacter pylori eradication rate of 83.6% was achieved with ten days of bismuth quadruple therapy in line with the Maastricht V/Florence recommended goal of at least 80%.

Helicobacter pylori eradication was independent of patient’s age and gender.

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Maria, C.R., Rodriguez, C.M., Ines, P. et al. Bismuth-Based Therapy: The New Therapy for Obese Patients Undergoing Gastric Bypass Surgery?. OBES SURG 34, 123–127 (2024). https://doi.org/10.1007/s11695-023-06549-8

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  • DOI: https://doi.org/10.1007/s11695-023-06549-8

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