Abstract
BackgroundThe eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70–85%. The aim of this study is to compare 7-day triple therapy versus 10-day sequential therapy as the first line treatment.MethodsData of 1240 H. pylori positive patients treated with triple therapy or sequential therapy from January 2013 to December 2015 were analyzed retrospectively. The patients who had undertaken previous H. pylori eradication therapy or gastric surgery were excluded.ResultsThere were 872 (74.3%) patients in the triple therapy group, and 302 (25.7%) patients in the sequential therapy group. There was no significant difference between the two groups regarding age, residence, comorbidities or drug compliance, but several differences were noted in endoscopic characteristics and indication for the treatment. The eradication rate of H. pylori by intention to treat analysis was 64.3% in the triple therapy group, and 81.9% in the sequential therapy group (P = 0.001). In per protocol analysis, H. pylori eradication rate in the triple therapy and sequential therapy group was 81.9 and 90.3%, respectively (P = 0.002). There was no significant difference in overall adverse events between the two groups (P = 0.706). For the rescue therapy, bismuth-containing quadruple therapy showed comparable treatment efficacy after sequential therapy, as following triple therapy.ConclusionsThe eradication rate of triple therapy was below the recommended threshold. Sequential therapy could be effective and tolerable candidate for the first-line H. pylori eradication therapy.
Highlights
The eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70–85%
The prevalence of Helicobacter pylori (H. pylori) infection has decreased over the past decade, changed from 66.9 to 54.4% between 1998 and 2011, but its prevalence is still high in Korea [1]
Triple therapy (TT) consists of proton-pump inhibitor (PPI), clarithromycin, and amoxicillin has been considered as standard first-line treatment for H. pylori in Korea since 1998 [9]
Summary
The eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70–85%. Eradication of H. pylori reduces the recurrence rate of peptic ulcer disease or recurrent gastric cancer after endoscopic resection of early gastric cancer, and it induces the remission of MALT lymphoma [4,5,6]. H. pylori eradication has critical role in Triple therapy (TT) consists of proton-pump inhibitor (PPI), clarithromycin, and amoxicillin has been considered as standard first-line treatment for H. pylori in Korea since 1998 [9]. The most important factor of reduced efficacy of TT is increasing antibiotic resistance of H. pylori, especially to clarithromycin [12].
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