Cerqueira Rute M, Correia M, Vilar H, Manso M C
Gastroenterology, S. Sebastião Hospital, Santa Maria da Feira, Portugal.
Biostastistics, Faculty of Health Sciences and FP-ENAS University Fernando Pessoa Porto Portugal LAQV-REQUIMTE University of Porto, Porto, Portugal.
Obes Surg. 2018 Mar;28(3):743-747. doi: 10.1007/s11695-017-2915-z.
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.
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.
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.
我们的目的是评估在接受 Roux-en-Y 胃旁路术（RYGB）的肥胖患者中，采用马斯特里赫特 IV 指南在克拉霉素高耐药率（CLT）地区的幽门螺杆菌（HP）累积根除率——14 天一线联合治疗，质子泵抑制剂（PPI）每日两次、CLT 500mg 每日两次、甲硝唑（MTZ）500mg 每日两次、阿莫西林（AMX）1000mg 每日两次，以及 14 天二线治疗，PPI 每日两次、AMX 1000mg 每日两次、左氧氟沙星（LVF）500mg 每日一次。单中心前瞻性研究历时 4 年。在基线时进行内镜检查和 HP 评估（通过组织学或 C13 尿素呼气试验），治疗结束后 4 - 6 周通过 C13 尿素呼气试验评估治疗后 HP 状态。
777 例连续的 HP 阳性患者完成了一线联合治疗：636 例（81.9%）为女性，年龄 41.1（±10.2）岁。556 例患者的 HP 被根除——71.56%（95%CI：68.28 - 74.62%）。在其余 221 例患者中，基于 LVF 的二线治疗方案使 121 例患者的 HP 被根除——54.75%（95%CI：48.16 - 61.18%）。这些结果得出意向性分析（ITT）累积根除率为 87.13%（95%CI：84.58 - 89.31%），符合方案分析（PP）累积根除率为 89.43%（95%CI：87.03 - 91.44%）。根除率在性别、年龄、内镜检查结果和吸烟习惯方面无显著差异。
通过采用马斯特里赫特 IV 共识四联一线联合治疗和基于 LVF 的二线治疗，可实现较高的 HP 累积根除率，但仍有大约 10.6%接受 RYGB 的肥胖患者在三线治疗前需要进行培养和药敏试验。
