Empirical 10-day sequential H. pylori eradication therapy could allow sparing of surgical intervention in chronic rhinosinusitis patients

Objective: To determine the association between H. pylori (Hp) infection and subjective and objective chronic rhinosinusitis (CRS) parameters and to evaluate the effect of empirical Hp-eradication therapy using the 10-day sequential therapy (ST) on these parameters. Patients and Methods: The study included 85 patients with manifestations of CRS, completed questionnaire to determine total subjective score (TSS) and underwent flexible nasal endoscopy, CT imaging, Urea Breath Test (UBT) and stool Hpantigen test. Patients were divided as Hp+ or Hp-. All patients received 10-day ST and responders were re-evaluated 3-m later, but non-responders were given another 10-day ST course and re-evaluated. Non-responders to ST courses and responders who developed recurrent symptoms underwent FESS. Results: 17 patients (20%) were Hp+; 11 in study and 6 in control groups. 12 Hp+ patients (70.5%) and 23 Hp- patients (33.8%) responded to ST, 5 Hp+ patients were assigned to 2nd ST course and 48 patients underwent FESS. Three of Hp+ patients responded to the 2nd ST course, while two underwent FESS. Seven of the responders to 1st ST course had recurred manifestations and underwent FESS, while 27 patients completed their follow-up uneventfully. Conclusion: Hp infection may underlie chronicity of CRS and is correlated with severity scores. 10-day ST for Hp eradication is being effective within short-time trial. Empirical ST provided improvement of CRS scoring and spared or postponed surgery in about 31.8% of patients, irrespective of being Hp+ or Hp-, so it is advocated as a first-line trial for patients presenting with symptoms suggestive of CRS.