Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina.
Clínica Monte Grande, Monte Grande, Buenos Aires, Argentina.
Obes Surg. 2024 Oct;34(10):3790-3795. doi: 10.1007/s11695-024-07505-w. Epub 2024 Sep 12.
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 people with obesity. The aim of the study is to examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric and metabolic surgery.
A post hoc analysis was conducted in a cohort of 204 adults patients (129 individuals diagnosed with obesity, 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.
Eradication rates were significantly lower in patients with obesity compared with normal weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13-0.63, p < 0.01). Furthermore, within the population diagnosed with obesity, 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).
Our results indicate that obesity may influence H. pylori eradication, especially among severe obesity patients undergoing bariatric surgery, which could have implications for the development of ulcers and gastritis as well as the risk of gastric cancer. Tailored eradication strategies may be necessary to improve treatment efficacy in this population.
全球肥胖患病率不断上升，成为主要的公共卫生挑战。然而，关于肥胖人群中幽门螺杆菌（H. pylori）根除的数据却很少。本研究旨在探讨肥胖程度对接受减重代谢手术患者 H. pylori 根除的影响。
对两项多中心前瞻性研究中 204 例 H. pylori 阳性肥胖（129 例）和正常体重（75 例）成年人患者进行了一项事后分析。患者接受了为期 14 天的四联伴随治疗，使用 13C-尿素呼气试验评估 H. pylori 根除情况。根据体重指数（BMI）对队列进行分层，并使用卡方检验、Kruskal-Wallis 检验和逻辑回归进行统计分析。
与正常体重患者相比，肥胖患者的根除率显著降低（68.2% vs. 88.0%，OR 0.29，95%CI 0.13-0.63，p<0.01）。此外，在肥胖患者人群中，肥胖程度与根除率降低相关，3 级（BMI 40.0-49.9）和 4 级（BMI≥50.0）肥胖的根除率最低（分别为 67%和 51%，OR 分别为 0.28 和 0.15，p<0.01）。
我们的研究结果表明，肥胖可能会影响 H. pylori 的根除，尤其是在接受减重手术的严重肥胖患者中，这可能会导致溃疡和胃炎的发生风险增加，以及胃癌的风险增加。可能需要制定针对肥胖患者的个体化根除策略以提高该人群的治疗效果。
