Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

Abstract Background 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 obese populations. Aim To examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric surgery. Methods A Post hoc analysis was conducted in a cohort of 204 adults patients (129 obese, 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. Results Eradication rates were significantly lower in patients with obesity compared to normal-weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13–0.63, p < 0.01). Furthermore, within the obesity group, 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). Conclusions Our results indicate that obesity significant influence H pylori eradication especially among severe obesity patients undergoing bariatric surgery. Tailored eradication strategies may be necessary to improve treatment efficacy in this population.