Standard Triple Therapy For Eradication Research Articles

Evaluation of the dynamics of symptoms of dyspepsia after eradication therapy in patients with Helicobacter pylori-associated gastritis

The treatment of functional dyspepsia remains a complex and incompletely resolved issue of gastroenterology. Subjective sensations of the patient, described as a feeling of fullness in the epigastrium after eating, early satiety, pain in the epigastrium, may be a manifestation of dyspepsia associated with Helicobacter pylori (H. pylori) infection. Aim was evaluation of the effectiveness of standard triple eradication therapy enhanced with bismuth tripotassium dicitrate for the relief of symptoms of dyspepsia in patients with H. pylori-associated chronic gastritis. Materials and Methods. The study involved 38 patients with H. pylori-associated chronic gastritis with symptoms of dyspepsia. The Questionnaire “7 × 7” was used to describe the dynamics of symptoms of dyspepsia. Results. At the initial examination, dyspeptic disorders in most patients corresponded the criteria for mild and moderate severity, respectively - 44.7% and 28.9% of patients. The severity of pain in the stomach area on average corresponded to a moderate pain syndrome, and the burning sensation was of low intensity. A feeling of fullness in the stomach after eating and/or early satiety was experienced by 76.3% of patients, pain disorders were observed in 92.1% of individuals. Two months after successful eradication treatment, complete relief of dyspepsia symptoms was noted in 57.9% of patients, and significant relief of symptoms of the combined form of dyspepsia in 23.7% of individuals. Conclusions: Successful standard triple eradication therapy enhanced with bismuth tripotassium dicitrate is effective for the treatment of dyspeptic symptoms in patients with H. pylori-associated chronic gastritis.

The influence of rosuvastatin on the efficacy of standard triple eradication therapy in patients with gallstone disease and Helicobacter pylori infection

The influence of rosuvastatin on the efficacy of standard triple eradication therapy in patients with gallstone disease and Helicobacter pylori infection

The treatment of helicobacter pylori-associated erosive lesions of gastroduodenal zone with the use of interactive learning technologies and rebamipide in young men

Purpose of the study. To evaluate the effectiveness of interactive teaching technologies and rebamipids in the complex therapy of erosive lesions of the gastroduodenal zone in young men.Material and research methods. Two groups of patients were examined. The observation group included 36 recruits with HP-associated gastritis with erosion (HSE) and duodenitis with erosion (DSE). Comprehensive treatment was used as a treatment: standard first-line triple therapy with the inclusion of rebamipide 100 mg 3 times a day for 14 days and interactive therapeutic training. The comparison group consisted of 18 patients with HP-associated GSE and DsE who received standard triple eradication therapy also for 14 days. The average age of the examined patients in the observation group was 21.0 ± 0.7 years, the comparison group was 20.1 ± 0.7 years.Results. The inclusion of Helicobacter pylori-associated gastritis and duodenitis with erosion of rebamipide and interactive learning technologies into the treatment regimen resulted in more effective relief of pain syndrome and dyspeptic manifestations in conscripts, restoration of mucus-forming and acid-producing functions of the stomach; to lower blood cortisol levels; reduce the degree of morphological activity of inflammation. There is a more effective eradication of Helicobacter pylori (91.7%) and epithelization of erosion (97.2%) in comparison with the standard scheme (88.9% and 94.4%, respectively). The use of interactive teaching technologies allowed to increase the level of medical activity and hygienic literacy (96.0% of recruits changed their diet, the nature of nutrition — 88.0%). The level of psycho-emotional status significantly improved after the treatment.Conclusion Combined therapy using rebamipide and interactive therapeutic training is effective in erosive lesions of the gastroduodenal zone in young men and increases patient adherence to treatment and leads to stabilization of psycho- emotional status.

Addition of bismuth to standard triple therapy for Helicobacter pylori eradication: a randomised controlled trial.

To compare the effect of addition of bismuth to the standard triple therapy for eradication of Helicobacter pylori (H. pylori) in a randomised controlled trial. The study was performed from June 2018-May 2019, in the two outpatient departments located at two different campuses of Ziauddin university hospitals (ZUH) Karachi. Ethical approval was obtained from the Ethics Review Committee of ZUH. It was designed as a randomized control trial in a parallel fashion. Arm A received triple therapy including amoxicillin, clarithromycin, and omeprazole for two weeks and Arm B received quadruple therapy adding colloidal bismuth subcitrate to the triple therapy. A stool antigen test was done six weeks post treatment to confirm H. pylori eradication. A total of 196 participants were included, out of which 102(52%) were males and 94 (48%) were females. Among the patients receiving quadruple therapy, 92/98(93.8%) had negative posttreatment stool antigen results, while among triple therapy recipients 83/98 (84.6%) had negative stool antigen results, according to intention-to-treat analysis (p value=0.038; odds ratio 2.77, 95% CI 1.03-7.47). However, p-value changed to 0.082 (odds ratio 2.40, 95% CI 0.87-6.60) in per-protocol analysis as stool antigen results were not available in two patients in the triple therapy arm. No difference in the side-effect profiles of either arm was noted. Eradication rates of H. pylori may be modestly improved by addition of bismuth to the standard triple therapy. 03968302 (clinicaltrials.gov).

1081P - Efficacy of salvage therapy in the treatment of Helicobacter pylori-positive gastric low-grade mucosa-associated lymphoid tissue lymphoma

BackgroundHelicobacter pylori (H.pylori) infection has a critical role in the pathogenesis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and its eradication can lead to tumor regression. However, in patients who do not achieve a lymphoma regression or relapse following antibiotic therapy, outcome of the patients are scarce. We evaluated the long-term outcome of the patients who received salvage therapy with relapsed or refractory gastric MALT lymphoma. MethodsBetween June 2000 and June 2017, a total of 29H.pylori-positive gastric MALT lymphoma patients who received frontline H.pylori eradication were included in this study. H.pylori-positive status was defined by positive results for the biopsy urease test and histology. They had all been diagnosed by endoscopy and had a complete staging including CT-scan. Patients received standard triple therapy for eradication of H.pylori and after treatment were sequentially followed-up with endoscopies performed to evaluate the response. Tumors that had resolved to complete remission (CR) score of GELA histologic grading system were considered treatment-responsive. ResultsDuring the follow-up periods 16 patients were refractory, nine had probable minimal residual disease and four relapsed after the first-line antibiotics. Of these 29 patients, transformation into high-grade B-cell lymphoma did not occur. Among the non-responder and relapsed patients, three patients were subjected to a watch and wait, while 26 patients underwent second-line treatment including radiotherapy (n=20), chemotherapy (n=5), chemotherapy plus sequential radiotherapy (n=1). Of the 20 patients treated with radiotherapy, the median dose to stomach was 3060 cGy (range, 1620-5000 cGy). After radiotherapy a CR was achieved in 20 patients (100%). Among six patients who received chemotherapy, a CR was achieved in five patients and no change was in one. That patient was achieved CR after radiotherapy. Probabilities of freedom from treatment failure and overall survival after 10 years were 100% and 83%. ConclusionsOutcome of patients with first-line H.pylori eradication failure followed by delayed chemotherapy and/or radiotherapy on indication was excellent. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Enterococcus faecium L-3 in Eradication of Helicobacter pylori: In-vivo and In-vitro

Usage of probiotics as component of anti-helicobacter therapy had been recently approved as a promising trend in the clinical practice. Over the years, we observed high efficacy of probiotic multi bacteriocinogenic strain Enterococcus faecium L-3 as an additional component of the standard triple therapy in eradication of Helicobacter pylori (H.p.) in patients with chronic gastritis associated with H. pylori infection. The cultivation of H.p. in the presence of live probiotic cultures of E. faecium L-3, Escherichia coli M17, Lactobacillus plantarum 8R-A3 showed superior antagonistic activity of enterococci relatively to other tested bacteria. The anti-helicobacter activity of chemically synthesized enterococcal bacteriocins EntB and Enxβ were studied using 6 strains of H. pylori. The strain-specific action of synthetic enterocins used was determined. Testing of sensitivity of H. pylori. to probiotics and their metabolites in vitro would be important for the selection and prediction of the clinical effectiveness of probiotics as well as development of new anti-helicobacter drugs and lines of combined therapies based on enterocins.

Usmerjeno zdravljenje okužbe z bakterijo Helicobacter pylori – ali še obstaja druga pot? Sistematični pregled literature in metaanaliza

Background. Empiric therapy is a mainstay of Helicobacter pylori eradication strategy. With the epidemics of antimicrobial resistance, it is becoming increasingly difficult to select treatment with at least two active antimicrobial agents, needed for cure. Tailored therapy has not been widely accepted in the past, but has lately resurged as a viable alternative. The aim of the study was to review all available studies comparing tailored and empiric therapy in treatment naïve adult patients.Methods. PubMed database search was conducted for eligible studies from 1996 to 2016 in English language. All relevant studies were included. Studies that compared standard triple and tailored therapy were included in the meta-analysis. Cumulative relative risk (RR) for eradication success was calculated.Results. Eight studies integrating 2521 participants were evaluated and 7 integrating 1853 patients were included in the meta-analysis. Different tailored approaches were recognized. However, all studies favoured tailored over empiric strategy. Cumulative RR was 1.27 (1.18-1.27) for intention-to-treat (ITT) analysis and 1.28 (1.18-1.38) for per-protocol (PP) analysis.Conclusion. Based on available evidence, tailored therapy is a better alternative to standard triple therapy for eradication of H. pylori. Evidence exist that such approach is also cost effective.

Role of adjuvant therapy in the treatment of helicobacter pylori infection in children.

The aim was to study the effect of combined probiotic containing Lactobacillus acidophilus, Bifidobacterium infantis, Enterococcus faecium, on H.pylori eradication efficacy in the treatment of children with chronic H.pylori- associated gastroduodenitis in the scheme of triple therapy of H.pylori eradication. Determination of total serum Ig M , A, G protein to Ag SagA H. pylori, breathing Helik test, rapid urease Helpil test ; that of concentration of serum sCD14 was conducted. The study group included 20 children who received standard triple eradication therapy for 7 days and 1 caps. of probiotic 3 times a day for 4 weeks, control group (20 children) – who received only standard eradication therapy. It is shown that combined use of probiotics in the treatment of Helicobacter pylori infection enhances effectiveness of eradication of H.pylori. In the basis of action of probiotic strains of the drug is an anti-inflammatory effect mediated by the impact on non-specific mechanisms of innate immunity, provided by molecular mechanism responsible for induction of sCD14 synthesis.

The efficacy and safety of adding the probiotic Saccharomyces boulardiito standard triple therapy for eradication of H.pylori: a randomized controlled trial.

Evaluating the efficacy and safety of adding the probiotic Saccharomyces boulardiito standard triple therapy for eradication of Helicobacter pylori. Several probiotics such as Saccharomyces boulardii have been investigated for their clinical efficacy. This probiotic, inhibit H. pylori urease by lowering the gastric pH, adhesion of H. pylori to gastric epithelial cells, stabilize the gastric barrier function and reduce the side effects of antibiotics. In this randomized controlled trial we evaluated 160 adult patients with biopsy confirmed H. Pylori infection referred to gastroenterology ward of Taleghani hospital. The patients were randomized into two treatment regimens: patients in group A (n = 80) were given amoxicillin (1000 mg, b.i.d), clarithromycin (500 mg, b.i.d), omeprazole (20 mg, b.i.d) and probiotic of saccaromyces boularidi (Yomogi) (250 mg, b.i.d) for 14 days, moreover patients in group B (n = 80) were given amoxicillin (1000 mg, b.i.d), clarithromycin (500 mg b.i.d) and omeprazole (20 mg,b.i.d) for 14 days. 160 patients (66 male 41.25%, 94female 58.75%) with the mean age of 47.1±11.4 years were evaluated. The success rate for H. pylori eradication in group A was higher 75(87.5%) than group B 65 (81.2%), but the difference between two groups was not significant (p = 0.350). Moreover, in case group side effects as nausea, diarrhea, abdominal discomfort and bloating were significantly lower than control group in first and second weeks. This study showed that saccaromyces boularidi decreased the adverse effects associated with H.pylori therapy but did not significantly decrease the eradication rate of H.pylori.

English

The study was undertaken to investigate the efficacy and safety of Saccharomyces boulardiicombined with proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori related peptic ulcer. One hundred patients with H. pylori infection were randomized in two groups: intervention and control group. Both groups were treated with the standard triple eradication therapy (omeprazole, amoxicillin and clarithromycin). The effective rate of the improvement in the treatment group was 96.0%, and was significantly higher than the control group (62.0%) (x2 = 6.899, P < 0.01). The pH of the two groups was also elevated after the treatment (P < 0.05, P < 0.05); the positive culture rate of bacteria increased obviously and there was significant difference between the two groups (P < 0.05). The eradication rate of H. pylori in the treatment group was 84.4% and was significantly higher than the control group (64.4%) (x2 = 5.848, P < 0.01). In addition, the rate of recurrence in the treatment group was 10.0%, while in the control group it was 26.0% after treated for one year (x2 = 11.584, P < 0.01). There was significant difference in the rate of adverse events between the two groups (15.6 and 57.8% of the treatment group and control group, respectively; x2 = 18.936, P < 0.01). Therefore, S. boulardii with PPI-based triple therapy for peptic ulcer is effective with a low recurrence rate and can reduce the incidence of adverse events.   Key words: Peptic ulcer, Helicobacter pylori, Saccharomyces boulardii, proton pump inhibitor (PPI)-based triple therapy.

Sequential Therapy for Helicobacter Pylori: A Two for One Deal That's Worth the Extra Effort?

Sequential Therapy for Helicobacter Pylori: A Two for One Deal That's Worth the Extra Effort?

A randomized, open trial evaluating the effect of Saccharomyces boulardii on the eradication rate of Helicobacter pylori infection in children

The failure rate of Helicobacter pylori (H. pylori) eradication imposes the assessment of new options. A prospective open study was performed in 90 symptomatic children (range 3-18 years) with H. pylori infection, randomized in two groups: control (42 patients) and intervention group (48 patients). Both groups were treated with the standard triple eradication therapy (omeprazole/esomeprazole, amoxicillin and clarithromycin) for 7-10 days. The intervention group was also treated with Saccharomyces boulardii (S. boulardii), 250 mg b.i.d., for 4 weeks. The eradication rate of H. pylori was assessed by the same methods (urease test and histology) 4-6 weeks after treatment. Adverse events and compliance were evaluated after 7 and 28 days of treatment. The Chi-square test was used for statistical evaluation (p < 0.05). H. pylori infection was identified in 90 of 145 children (62%) and it correlated positively with age (p < 0.002) and inversely with socioeconomic status (p < 0.005). All infected children had chronic gastritis, with antral nodularity in 76.7%. Overall, H. pylori eradication rate was 87.7% (control 80.9%, S. boulardii group 93.3%) (p = 0.750). The incidence of side effects was reduced in the S. boulardii group: 30.9% in the control versus 8.3% in the probiotic group (p = 0.047). The addition of S. boulardii to the standard eradication treatment confers a 12% nonsignificant enhanced therapeutic benefit on H. pylori eradication and reduces significantly the incidence of side effects.

Meta-analysis: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naive to Treatment

Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious. To compare sequential therapy with standard triple therapy for H. pylori infection. MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used. Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection. 3 reviewers independently assessed trial eligibility and quality and extracted data on eradication. The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n = 1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to 77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles. Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias. Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.

Long‐term aspects of nodular gastritis in children

Close association of nodular gastritis and Helicobacter pylori infection has been initially proved by various studies. There have been some studies reporting microscopic and histologic recovery in a short time after eradication therapy. But there is not enough data about the long-term course of this condition. The aim of this study is to document current clinical conditions, presence of H. pylori and results of endoscopic and histologic examination, after a long-term period, in children with endoscopically diagnosed antral nodularity. A total of 35 patients diagnosed as nodular antral gastritis by upper gastrointestinal endoscopy during a 2 year period, were invited for re-evaluation and re-endoscopy after 3 years. Histopathologically, H. pylori detected ones had been treated with standard triple eradication therapy. In total, 27 patients were accepted for enrollment in the study. Repeated endoscopy could be performed in all 27 patients. The persistence of antral nodularity was detected in 18 of 27 patients. Decrease in symptoms, absence of symptoms and presence of H. pylori infection were detected in 6, 8 and 16 (89%) of them, respectively. There was no statistical significance between the first and last endoscopic biopsies when activity, atrophy, intestinal metaplasia and presence of follicles were regarded. Malt lymphoma could not be detected in any of the patients. There is a strong association between nodular gastritis and H. pylori. Presence of antral nodularity in the long-term period may be related to H. pylori re-infection. New therapeutic approaches are required for treatment and management of the patients diagnosed as nodular gastritis and living in areas endemic for H. pylori infection.

Helicobacter pylori Eradication: A Randomized Prospective Study of Triple Therapy Versus Triple Therapy Plus Lactoferrin and Probiotics

Helicobacter pylori is causally associated with gastritis and peptic ulcer diseases. Recent data (meta-analysis) have demonstrated that triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor has an eradication rate of only 74-76% and new therapeutic protocols may be necessary. The aim of this study was to examine whether adding bovine lactoferrin (bLf) and probiotics (Pbs) to the standard triple therapy for H. pylori infection could improve the eradication rate and reduce side effects. H. pylori infection was diagnosed in 206 patients: in 107 based on an upper endoscopy exam and a rapid urease test, and in 99 by means of the H. pylori stool antigen-test and the C(13) urea breath test (C(13) UBT). The patients were randomized into two groups: 101 patients (group A) underwent standard triple eradication therapy (esomeprazole, clarithromycin, amoxicillin), while 105 patients (group B) underwent a modified eradication therapy (standard triple eradication therapy plus bLf and Pb). Successful eradication therapy was defined as a negative C(13) UBT 8 wk after completion of the treatment. Results were evaluated by intention-to-treat (ITT) and per-protocol (PP) analysis. Data were evaluated and considered positive when P<0.05. At the end of the study 175/206 patients showed negative C(13) UBT results. According to intention-to-treat analysis, the infection was eradicated in 73/101 patients from Group A and in 93/105 from Group B. PP analysis showed 73/96 patients from Group A and 93/101 from Group B to have been successfully treated. More patients from group A than from group B reported side effects from their treatment (P<0.05). The results of our study suggest that the addition of bLf and Pbs could improve the standard eradication therapy for H. pylori infection--bLf serving to increase the eradication rate and Pbs to reduce the side effects of antibiotic therapy.

Accuracy of a new monoclonal stool antigen test in post-eradication assessment of Helicobacter pylori infection: Comparison with the polyclonal stool antigen test and urea breath test

Background and aim. The enzyme immunoassay based on polyclonal antibodies (HpSA) represents a valid method for the detection of Helicobacter pylori antigens in stool specimens, but some controversial results were reported in post-eradication setting. A new monoclonal enzyme immunoassay (FemtoLab H. pylori, Connex) has been developed. The present study compares the diagnostic accuracy of the two tests after eradication therapy. Patients and methods. Stool samples were collected and urea breath test and endoscopy performed in 325 patients (161 F, 164 M, age 17–78 years), 4–8 weeks after standard triple eradication therapy. The FemtoLab and HpSA tests were performed in accordance with the manufacturer's protocol. H. pylori infection was confirmed if culture alone or both urease test and histology were positive and was considered absent if all three tests were negative. Results. H. pylori was eradicated in 231 patients (71.1%). Urea breath test showed the best performances with sensitivity 98.9% and specificity 99.5%. The sensitivity of FemtoLab was 88.3%, specificity 94.8%, positive and negative predictive values 87.4% and 95.2%. Corresponding HpSA values were 73.4%, 97.8%, 93.2% and 90%. Sensitivity and negative predictive value of FemtoLab were significantly better than HpSA. Adjusting the cut-offs according to a ROC curve improved not significantly the sensitivity of the two tests. Conclusions. Urea breath test shows the best accuracy in the assessment of H. pylori infection. Between the stool tests, the FemtoLab due to its higher sensitivity is to prefer in the post-eradication assessment of H. pylori infection.