Abstract
Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcer disease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However, standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy for H. pylori eradication. In this prospective single center study, H. pylori infected gastritis patients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo. Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycin MR once daily and 1,048 mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt without probiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication was defined as a negative 13C-urea breath test at least 2 weeks after completion of treatment. One hundred subjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%, 49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14 regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantly lower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%; p=0.04). The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent cure rate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19 genotype. Adding a probiotic also reduced treatment-related adverse events.
Highlights
Helicobacter pylori (H. pylori) is a gram-negative bacteria, which has been proven to be etiologically associated with gastric cancer and peptic ulcer disease (Vilaichone and Mahachai, 2001, Vilaichone et al, 2006)
Triple therapy is still suggested in the areas where the rate of clarithromycin resistance is low, or when the treatment is chosen based on the antibiotic susceptibility testing
Eradication of H. pylori infection All 100 patients completed the study without any drop out
Summary
Helicobacter pylori (H. pylori) is a gram-negative bacteria, which has been proven to be etiologically associated with gastric cancer and peptic ulcer disease (Vilaichone and Mahachai, 2001, Vilaichone et al, 2006). Triple therapy is still suggested in the areas where the rate of clarithromycin resistance is low, or when the treatment is chosen based on the antibiotic susceptibility testing. Asian Pacific Journal of Cancer Prevention, Vol 15, 2014 9909 antibiotic resistance, including smoking, the dosage and duration of treatment. An extended duration of PPI and clarithromycin-containing triple therapy from 7 to 10-14 days improved the eradication rate by about 5% (Malfertheiner et al, 2012). Bismuth-based triple therapy for H. pylori eradication has been shown to increase cure rate with minimal side effects (Ford et al, 2008, Fock et al, 2009). We report a prospective randomized trial evaluating H. pylori eradication by using standard triple therapy plus bismuth with or without probiotic supplement for 7 or 14 days. The effects of CYP2C19 genotype and antibiotic resistance were examined
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