Evaluation of Three Helicobacter pylori Eradication Protocols in a Digestive Endoscopy Center in Dakar

Abstract

Introduction: The treatment of Helicobacter pylori (H. pylori) requires the combination of antibiotic therapy with an antisecretory agent. Due to increasing antibiotic resistance, which varies from one geographical region to another, several eradication protocols exist. Objective: The objective is evaluate and compare the efficacy of three treatment regimens for H. pylori infection: 1) Arm A: Omeprazole + Amoxicillin + Clarithromycin for 10 days; 2) Arm B: Omeprazole + Amoxicillin + Metronidazole for 10 days; 3) Arm C: Sequential treatment = Omeprazole + Amoxicillin for 5 days then Omeprazole + Clarithromycin + Metronidazole for 5 days. Patients and Method: This was a prospective randomised study conducted from February 2016 to July 2016 and from April 2017 to September 2017 in the digestive endoscopy center of the gastroenterology and hepatology department of the University Hospital Center Aristide Le Dantec. Our study population consisted of all patients aged 18 years or older referred for upper GI endoscopy. We included all patients whose indication for the examination was epigastralgia and/or dyspepsia and whose rapid urease test was positive. Patients were randomized to the different treatment arms. A 13C-urea breath test was performed at least 4 weeks after stopping antibiotics and 2 weeks after stopping proton pump inhibitor (PPI). Results: We included 120 patients. There were 95 women and 25 men. The mean age was 40 years. Epigastralgia and dyspepsia were present in 90% and 59% of cases, respectively. Upper GI endoscopy showed peptic ulcer in 19.2% and gastroduodenal erosions in 42.5%. The distribution of patients in the different treatment arms was as follows: 40 patients in arm A, 39 patients in arm B and 41 patients in arm C. Treatment was effective in 71.7% of cases in all arms mixed up. Arms A, B and C were effective in 92.5%, 28.2% and 92.7% of cases respectively. The efficacy of arms A and C was like and greater than that of arm B. Conclusion: The therapeutic strategy for H. pylori must consider the local microbiological and ecological environment. Clarithromycin triple therapy and sequential treatment represent effective protocols in our patients.