Patients with obesity are frequently underrepresented in Helicobacter pylori (H pylori) trials. In this population, physiological alterations including increased volume of distribution of hydrophilic antibiotics such as amoxicillin may result in subtherapeutic mucosal concentrations with standard fixed doses, contributing to suboptimal eradication rates in Metabolic and Bariatric Surgery (MBS) candidates. We evaluated the effectiveness and safety of a weight-adjusted amoxicillin regimen for improving H. pylori eradication in patients with obesity scheduled for MBS.