36 Comparsion of effectiveness of two one week treatment regimens for H.Pylori in south of ireland patient cohort

Abstract

Background H. pylori eradication rates for 7 day triple therapy regimens have decreased in many countries in recent years. Recent European guidelines recommend that standard triple therapy should not be used where local H. pylori resistance rates are greater than 15%. Aim Aim of study was to compare H. pylori eradication rates of one week, metronidazole vs Chlarithromycin based, triple therapy regimens in a south of Ireland patient cohort. Method From January 2015 to September 2016 undergoing upper GI endoscopy by two gastroenterologists at the Bon Secours Hospital Cork had H. pylori status determined by CLO test (BioHIT). All Clo positive patients received one of two seven day H. pylori treatment regimens; PPI, Amoxycillin, Clarithromycin (PAC) or PPI, Amoxycillin, Metronidazole (PAM). All treated patients were offered urea breath test (Diabact UBT)3- 4 months following treatment. Results Of 2595 patients having upper endosocpy 188 (7.2%) had positive CLO tests.45% (106/188) were females and mean age 56 (17 to 84 years).Of the 188 Clo positive patients,118 (63%) received PAC treatment and 70 (37%) received PAM treatment. Of the 118 PAC patients 83 (69%) attended for UBT and 24 (29%) were positive. Of the 70 patients treated with PAM 50 (71%) returned for UBT and 14 (28%) were positive. Conclusions In a patient cohort with relatively low H.pylori infection rates, one week based Clarithromycin and Metronidazole based triple therapy regimens achieved equivalent eradication of H.pylori (71% PAC,72% PAM). H. pylori eradication rates are somewhat higher than recently reported in Ireland, they are well short of current European guidelines and add further weight to the recommendation that one week triple therapy regimen should not be used in this country for first line H. pylori eradication.