Triple Therapy For Helicobacter Pylori Research Articles

Comparison of metronidazole versus clarithromycin in first-line vonoprazan-based triple therapy for Helicobacter pylori: A multicenter randomized trial in Japan.

To date, no randomized trials have compared the efficacy of 7-day vonoprazan, amoxicillin, and metronidazole triple therapy (VAM) versus 7-day vonoprazan, amoxicillin, and clarithromycin triple therapy (VAC) as a first-line treatment for Helicobacter pylori eradication. This study was performed to compare the efficacy of VAM and VAC as first-line treatments. This prospective multicenter randomized trial was performed in Japan and involved 124 H. pylori-positive patients without a history of eradication. Patients without antibiotic resistance testing of H. pylori were eligible. The patients were randomized to receive either VAC (vonoprazan 20 mg + amoxicillin 750 mg + clarithromycin 200 or 400 mg twice a day) or VAM (vonoprazan 20 mg + amoxicillin 750 mg + metronidazole 250 mg twice a day) for 7 days, with stratification by age and sex. Eradication success was evaluated using the 13C-urea breath test. We evaluated safety using patient questionnaires (UMIN000025773). The intention-to-treat and per-protocol eradication rates of VAM were 91.3% (95% confidence interval [CI], 82.0-96.7%) and 92.6% (95% CI, 83.7-97.6%), respectively, and those of VAC were 89.1% (95% CI, 77.8-95.9%) and 96.1% (95% CI, 86.5-99.5%), respectively. No significant difference was observed between VAM and VAC in either analysis (P = 0.76 and P = 0.70, respectively). Abdominal fullness was more frequent in patients who received VAM than VAC. These findings suggest that VAM as a first-line treatment in Japan can be categorized as grade B (intention-to-treat cure rate of 90-95%) and have potential as a first-line national insurance -approved regimen.

Association between failed eradication of 7-day triple therapy for Helicobacter pylori and untreated dental caries in Japanese adults

Helicobacter pylori (H. pylori) infection is a cause of gastric disorders and is treated mainly by pharmacotherapy with antimicrobial agents. An association has been reported between dental caries and H. pylori infection. As antimicrobial agents are less effective inside dental caries because of impaired blood circulation, the presence of untreated dental caries (decayed teeth) may influence the success of H. pylori eradication treatment. In this cross-sectional study, we examined whether failed eradication of H. pylori was associated with decayed teeth in Japanese adults. Enrolled were 226 participants who received dental checkups among those treated for eradication of H. pylori at Asahi University Hospital between April 2019 and March 2021. Treatment efficacy was assessed by urea breath test. Eradication failed in 38 participants (17%), decayed teeth in 32 participants (14%), and number of 0.34 teeth per participants. Multivariate logistic regression analyses showed that failed eradication of H. pylori was associated with decayed teeth (presence: odds ratio, 2.672; 95% confidence interval, 1.093–6.531) after adjusting for gender, age, and brushing frequency. These results indicate that failed eradication of H. pylori was associated with decayed teeth and suggest that untreated dental caries may impact treatment for eradication of H. pylori.

Vonoprazan-Based versus Esomeprazole-Based Triple Therapy for Helicobacter Pylori: A Randomized Trial

Vonoprazan-Based versus Esomeprazole-Based Triple Therapy for Helicobacter Pylori: A Randomized Trial

S1607 The Efficacy of Bismuth Based Quadruple Therapy Compared With Clarithromycin-Based Triple Therapy for Helicobacter pylori in a Predominantly Hispanic Population: A Retrospective Cohort Study

Introduction: Helicobacter pylori has a prevalence of approximately 35% in the United States. Infection rates and antibiotic resistance are reported to be higher in immigrants from endemic areas such as Latin America. Clarithromycin based triple therapy had been used as the first line treatment; however, the updated ACG H. pylori guidelines in 2017 recommends bismuth based quadruple therapy as the first line treatment in a population with suspected clarithromycin resistance. The aim of this study was to evaluate the effectiveness of bismuth quadruple therapy compared with clarithromycin triple therapy in a predominantly Hispanic population on the US- Mexico border, as well as to assess the impact of insurance status and the 2017 ACG guidelines on the choice of treatment regimen. Methods: A retrospective cohort study of adult patients with H. pylori infection treated with clarithromycin triple therapy or bismuth quadruple therapy at a tertiary care county hospital on the US-Mexico border from January 2009 to March 2022 was conducted. Patients with unknown treatment regimens or an absence of an eradication test were excluded from the analysis. A logistic regression model adjusting for propensity scores using the inverse probability treatment weighting method was used to determine the relationship between eradication status and the treatment regimen. The analyses were adjusted for, age, gender, ethnicity, insurance, diabetes, smoking, illicit drug use, and PPI use. Results: A total of 938 patients were included, 201 patients (21.4%) in the quadruple regimen group and 737 patients (78.6%) in the triple regimen group. Mean age was 51 years, female (70.8%), Hispanic (90.4%), and non-insured patients (29.4%). The H. pylori eradication rate with quadruple therapy was significantly higher compared with triple therapy (91.5% vs 83.2% P=0.004) in unadjusted analysis and after adjusting for propensity scores (OR 2.43; 95% CI: [1.38 - 4.27], P=0.002). Following the 2017 ACG guidelines, the rate of using quadruple as the first line therapy increased from 11.1% to 24.6% (P< .0001). Furthermore, quadruple regimen therapy was more likely to be prescribed for insured (79.1%) compared with non-insured (20.9%) patients (P< 0.001) (Table). Conclusion: In a predominantly Hispanic population, bismuth quadruple therapy is more effective in H. pylori eradication compared with clarithromycin triple regimen. However, insurance status seems to influence the choice of recommended regimen in this high-risk population. Table 1. - Comparisons of characteristics between initial treatment regimens Initial Treatment Regimens Factor Bismuth Quadruple Clarithromycin Triple P-value N 201 737 Age (years) 0.017 Age at testing, mean (SD) 53.92 (13.44) 51.33 (13.66) Gender 0.080 Female 132 (65.67%) 532 (72.18%) Male 69 (34.33%) 205 (27.82%) Ethnicity 0.54 Non-Hispanic 16 (7.96%) 69 (9.36%) Hispanic 185 (92.04%) 668 (90.64%) Insurance status 0.003 No 42 (20.90%) 234 (31.75%) Yes 159 (79.10%) 503 (68.25%) Diabetes 0.93 No 151 (75.12%) 550 (74.63%) Yes 50 (24.88%) 187 (25.37%) Smoking history 0.76 No 165 (82.09%) 594 (80.82%) Yes 36 (17.91%) 141 (19.18%) Illicit drug use 0.58 No 195 (97.50%) 718 (98.09%) Yes 5 (2.50%) 14 (1.91%) PPI use before diagnosis 1.00 No 149 (75.63%) 547 (75.66%) Yes 48 (24.37%) 176 (24.34%) Type of eradication test < 0.001 Endoscopic biopsy 25 (12.44%) 69 (9.39%) Stool test 120 (59.70%) 302 (41.09%) Breath test 56 (27.86%) 364 (49.52%) Result of eradication test 0.004 Positive (failure of eradication) 17 (8.46%) 123 (16.73%) Negative (successful eradication) 184 (91.54%) 612 (83.27%) Gastric cancer 1.00 No 198 (99.50%) 725 (99.04%) Yes 1 (0.50%) 7 (0.96%) SD: standard deviation; PPI: proton pump inhibitor.

Triple Therapy-Based on Tegoprazan, a New Potassium-Competitive Acid Blocker, for First-Line Treatment of Helicobacter pylori Infection: A Randomized, Double-Blind, Phase III, Clinical Trial

Background/AimsWe examined the efficacy and safety of tegoprazan as a part of first-line triple therapy for Helicobacter pylori eradication.MethodsA randomized, double-blind, controlled, multicenter study was performed to evaluate whether tegoprazan (50 mg)-based triple therapy (TPZ) was noninferior to lansoprazole (30 mg)-based triple therapy (LPZ) (with amoxicillin 1 g and clarithromycin 500 mg; all administered twice daily for 7 days) for treating H. pylori. The primary endpoint was the H. pylori eradication rate. Subgroup analyses were performed according to the cytochrome P450 (CYP) 2C19 genotype, the minimum inhibitory concentration (MIC) of amoxicillin and clarithromycin, and underlying gastric diseases.ResultsIn total, 350 H. pylori-positive patients were randomly allocated to the TPZ or LPZ group. The H. pylori eradication rates in the TPZ and LPZ groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.009 and p=0.013), respectively. Subgroup analyses according to MICs or CYP2C19 did not show remarkable differences in eradication rate. Both first-line triple therapies were well-tolerated with no notable differences.ConclusionsTPZ is as effective as proton pump inhibitor-based triple therapy and is as safe as first-line H. pylori eradication therapy but does not overcome the clarithromycin resistance of H. pylori in Korea (ClinicalTrials.gov identifier NCT03317223).

Saccharomyces boulardii CNCM I-745 supplementation modifies the fecal resistome during Helicobacter pylori eradication therapy.

The gut microbiota is a significant reservoir of antimicrobial resistance genes (ARGs). The use and misuse of antimicrobials can select multi-resistant bacteria and modify the repertoire of ARGs in the gut. Developing effective interventions to manipulate the intestinal resistome would allow us to modify the antimicrobial resistance risk. Applying shotgun metagenomics, we compared the composition of fecal resistome from individuals treated with triple therapy for Helicobacter pylori plus Saccharomyces boulardii CNCM-I 745 (Sb) versus triple antibiotherapy without S. boulardii (control) before, after, and one month after treatments. DNA samples were sequenced on an Illumina NovaSeq 6000 platform. Reads were trimmed and filtered for quality, and the reads classified as host genome were removed from further analysis. We used the ResFinder database for resistome analysis and the web-based tool ResistoXplorer and RStudio for graphical representation and statistical analysis. We identified 641 unique ARGs in all fecal samples, conferring resistance to 18classes of antibiotics. The most prevalent ARGs found in at least 90% of the samples before the treatments were against tetracyclines, MLS-B (macrolide, lincosamide, and streptogramin B), beta-lactams, and aminoglycosides. Differential abundance analysis allowed the identification of ARGs significantly different between treatment groups. Thus, immediately after the treatments, the abundance of ARGs that confer resistance to lincosamides, tetracyclines, MLS-B, and two genes in the beta-lactam class (cfxA2 and cfxA3) was significantly lower in the group that received Sb than in the control group (edgeR, FDR <0.05). Our study demonstrated that the addition of S. boulardii CNCM-I 745 to the conventional antibiotic eradication therapy for H. pylori reduced the abundance of ARGs, particularly those genes that confer resistance to lincosamides, tetracyclines, MLS-B, and a few genes in the beta-lactams class.

The prolongation effect of ilaprazole-based standard triple therapy for Helicobacter pylori: Erratum.

The prolongation effect of ilaprazole-based standard triple therapy for Helicobacter pylori: Erratum.

The prolongation effect of ilaprazole-based standard triple therapy for Helicobacter pylori.

Background:Helicobacter pylori (HP) infection causes many diseases, such as peptic ulcers, gastritis and gastric cancer, and MALToma. It has been gradually accepted that all HP-infected patients should be treated because HP is regarded as an infection. Therefore, the importance of selecting the optimal treatment regimen has increased. Although the 14-day standard triple therapy (STT) is recommended in the current guidelines, prolonging treatment duration is controversial in real practice because of inconsistent results from previous data and the risk of adverse effects. Additionally, the effect of STT using ilaprazole has not been reported until now. We aimed to compare the eradication rate between 7 and 10 days STT using ilaprazole.Methods:A prospective randomized controlled trial was conducted, which was divided into 2 treatment groups: the control group was 7 days of STT, and the test group was 10 days of STT. The eradication regimen was 10 mg ilaprazole, 500 mg clarithromycin, and 1000 mg amoxicillin twice daily. We included patients who were diagnosed with positive results of H pylori examination. We compared the HP eradication rate according to treatment duration, CYP2C19 subtype and endoscopic diagnosis.Results:We enrolled a total of 254 patients consisting of 127 patients in each treatment arm. The eradication rates of the control and test groups were 65.4% (82/127) and 74.8% (95/127), respectively, in the intention-to-treat analysis (P = .1). In the per-protocol analysis, 70.3% (83/118) and 82.6% (94/115) were eradicated in each group, which was statistically significant (P = .027). The CYP2C19 subtype was examined in 230 patients. The eradication rate was 79.2% (57/72), 75.4% (92/122), and 72.2% (26/36) in each group, which was not significantly different (P = .704).Conclusion:Ten-day STT was more effective than 7-day STT for HP eradication. The eradication rate was not affected by the CYP2C19 genotype.

2668 Pleural Effusion From an Unexpected Source!

INTRODUCTION: Gastric adenocarcinoma (GAC) is a global health burden. It is the third-leading cause of cancer-related mortality. Diagnosis is often delayed given the non-specific symptoms attributed to this disease. Gastric cancer is well known to cause distant metastases to other organs. However, it is unusual for patients to develop malignant pleural effusion as a presenting manifestation. Our case illustrates a unique diagnosis of an occult GAC after initial presentation with shortness of breath that deemed to be due to a malignant pleural invasion by signet ring cell cancer of the stomach. CASE DESCRIPTION/METHODS: A 70-year-old woman presented with worsening dyspnea and orthopnea of 1-month duration. Her past medical history included asthma and hypertension. Initial evaluation revealed a saturation of 98% on room air with decreased breath sounds halfway up upon auscultation of the right lung. Chest x-ray demonstrated a moderate right pleural effusion. Thoracentesis was performed with removal of 1 L of amber-colored fluid. The cytological analysis revealed adenocarcinoma with signet ring cell features. Upper endoscopy showed an 8 cm irregular necrotic ulcer at the lesser curvature of the stomach. Pathology confirmed the presence of a moderately differentiated infiltrative signet ring cell adenocarcinoma. Giemsa stain revealed helicobacter pylori (HP). Immuno-histochemical stains were positive for CK 7, hMLH1, 2 and 6. A positron emission tomography showed evidence of metastasis in right pleural space and lumbar spine. The patient received triple therapy for HP and confirmed eradication as well as modified FOLFOX 6 therapy every two weeks. DISCUSSION: Gastric adenocarcinoma is the fifth most common cancer in the world. Helicobacter pylori is a well recognized underlying risk factor for GAC. Around 1-3% of patients infected with HP progress to develop GAC. Chronic infection in this setting results in hypochlorhydria that leads to atrophic gastritis and intestinal metaplasia followed by dysplasia and subsequent neoplasia. Malignant pleural effusion is a rare presenting manifestation of GAC accounting for only two percent of cases. In advanced stage GAC, common metastatic sites include distant lymph nodes, liver, peritoneum with rare metastasis to lungs, bone, brain, and leptomeningeal space. Our case was distinctive as the pleural effusion was the initial presentation of an occult GAC diagnosed after that. Prognosis of metastatic GAC remains poor because of limited effective therapies.

Modification of gastric cancer risk associated with proton pump inhibitors by aspirin after Helicobacter pylori eradication.

AimAlthough proton pump inhibitors (PPIs) can prevent aspirin-induced upper gastrointestinal bleeding, a clinical dilemma exists as long-term use of PPI may also increase the risk of gastric cancer even after Helicobacter pylori (HP) eradication. We aimed to investigate the potential interaction between aspirin and PPIs on GC risk in patients who have HP eradicated.ResultsOf the 63,397 HP eradicated subjects (median follow-up 7.6 years), 153 (0.24%) developed GC. PPIs were associated with a higher GC risk among non-aspirin users (aHR: 3.73, 95% CI:2.11–6.60) but not among aspirin users (aHR: 0.35, 95% CI:0.04–2.74).Materials and MethodsThis is a post-hoc analysis based on a previously published territory-wide retrospective cohort study on the potential risk of PPIs on GC. Adults who had received an outpatient prescription of clarithromycin-based triple therapy for HP between 2003 and 2013 were identified. The adjusted hazard ratio (aHR) of GC with PPIs, stratified according to aspirin use, was calculated by Cox model with propensity score adjustment of other covariates.ConclusionsThe potential harmful effects of PPIs on GC development appear to be limited to non-aspirin users. Co-prescription of PPIs is therefore recommended for HP-eradicated patients who are at risk of aspirin-induced UGIB.

Tu1302 - Vonoprazan- Versus Proton-Pump Inhibitor-Based Third-Line 7-Day Sitafloxacin-Containing Triple Therapy for Helicobacter Pylori: A Prospective, Randomized Trial

Tu1302 - Vonoprazan- Versus Proton-Pump Inhibitor-Based Third-Line 7-Day Sitafloxacin-Containing Triple Therapy for Helicobacter Pylori: A Prospective, Randomized Trial

Evaluation of efficacy and safety of rebamipide use in the triple therapy for Helicobacter pylori eradication: a pilot study

The article presents the results of a pilot prospective randomized study aimed at evaluating the efficacy and safety of rebamipide (Rebagit, PRO.MED.CS Praha a.s., Czech Republic) as part of the triple therapy for helicobacter pylori (H. Pylori) eradication. 54 patients with H. pylori-associated gastric ulcer/duodenal ulcer were enrolled to the study. All patients were randomized to two therapeutic groups depending on the eradication therapy to be received. Group 1 received the standard triple therapy, Group 2 received the standard triple therapy plus rebamipide. The efficacy of H. pylori eradication in Group 1 amounted to 78,2% (ITT), 81,8% (PP), and in Group 2 to 83,8% (ITT), 86,6% (PP). Odd ratio of efficient eradication with the use of rebamipide as part of standard triple therapy for helicobacter pylori eradication was 1,44 (95 CI: 0,36–5,72). The side effect rates between the groups were comparable

Luminal Clinical

<b>Luminal Clinical</b>

Effect of CYP2C19 Gene Polymorphisms on Proton Pump Inhibitor, Amoxicillin, and Levofloxacin Triple Therapy for Eradication of Helicobacter Pylori.

BackgroundThe effects of PPI are variable owing to the CYP2C19 polymorphisms. However, whether the polymorphisms could affect the Hp eradication efficacy of triple therapy is still not clear. The present study aimed to assess the effects of CYP2C19 gene polymorphisms on proton pump inhibitor (PPI), amoxicillin, and levofloxacin triple therapy for Helicobacter pylori (Hp) eradication.Material/MethodsWe randomly assigned 160 Hp-positive patients with chronic gastritis to 2 groups to receive either 20 mg bid omeprazole (OAL group, n=80) or 10 mg bid rabeprazole (RAL group, n=80), combined with 1000 mg bid amoxicillin and 500 mg qd levofloxacin. The 2 groups were treated for 10 days. The CYP2C19 genotypes included wild-type, M1 mutant gene (*2, the mutation of exon 5), and M2 mutant gene (*3, the mutation of exon 4) identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFIP). According to CYP2C19 genotype combinations, the patients were divided into extensive metabolizer (EM), intermediate metabolizer (IM), and poor metabolizer (PM) subgroups. The eradication efficacy of Hp was evaluated by 14C-UBT at 28 days after treatment.ResultsThe trial was completed by 155 patients. Hp eradication rates in OAL and RAL groups were 78.2% and 88.3%, respectively, on per-protocol (PP) analysis, indicating no significant difference (P>0.05). Regarding CYP2C19 genotypes, eradication rates of 60.7%, 84.2%, and 100% were obtained for EM, IM, and PM subgroups, respectively, of the OAL group. EM group eradication rates were significantly lower than IM and PM group values (P<0.05). In the RAL group, no such difference was observed (P>0.05). Hp eradication rates were significantly lower in the EM subgroup of the OAL group compared with that of the RAL group.ConclusionsHp eradication rates were higher in the RAL group than in OAL-treated patients. Interestingly, omeprazole-based therapy was significantly affected by the CYP2C19 genotype, unlike the rabeprazole-based therapy.

Sa1195 - Polaprezinc Combined with Triple Therapy for Helicobacter Pylori Associated Gastritis: A Prospective, Multicenter, Randomized Clinical Trial

Sa1195 - Polaprezinc Combined with Triple Therapy for Helicobacter Pylori Associated Gastritis: A Prospective, Multicenter, Randomized Clinical Trial

Analysis of the cost-effectiveness of using vonoprazan–amoxicillin–clarithromycin triple therapy for first-line Helicobacter pylori eradication

Background: Vonoprazan (VPZ)-based triple therapy has been reported to have greater efficacy than a proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) eradication. However, because VPZ is more expensive than PPIs such as rabeprazole (RPZ), economic evaluation is essential.Methods: We performed a retrospective study on 209 patients who underwent first-line eradication of H. pylori infection in Fuyoukai Murakami Hospital from 1 March 2015 to 31 March 2016. Patients who received VPZ, amoxicillin (AMPC) and clarithromycin (CAM) were assigned to the VPZ/AC group (n = 111) and patients who received RPZ, AMPC and CAM to the RPZ/AC group (n = 98). We compared the patients’ backgrounds, including age, gender, use of high-dose CAM, past history of peptic ulcer, smoking and drug-related adverse events between the two groups. We defined cost as direct medical costs per patient and effectiveness as the first-line eradication rate in the intention-to-treat (ITT) analysis and analyzed the cost-effectiveness using the cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER).Results: There was no significant difference in the patients’ backgrounds. The ITT analysis revealed an eradication rate of 94.6% for VPZ/AC and 86.7% for RPZ/AC. VPZ/AC cost 1155.4 Japanese yen (JPY) higher than RPZ/AC (34063.4 vs. 32908.0, JPY). CER of VPZ/AC was less than that of RPZ/AC (360.1 vs. 379.4, JPY per percent) and ICER of VPZ/AC was 147.0 JPY (1.28 Euro (EUR), 1 EUR =115 JPY) per percent.Conclusions: VPZ/AC was more cost-effective than RPZ/AC as first-line therapy for H. pylori eradication.

Mutations affecting domain V of the 23S rRNA gene in Helicobacter pylori from Cairo, Egypt

Background: Clarithromycin is a main component of the recommended first-line triple therapy for Helicobacter pylori in Egypt. We aimed in our study to investigate the prevalence of clarithromycin-resistant H. pylori strains due to the point mutations at domain V of the H. pylori 23S rRNA among the Egyptian population using the polymerase chain reaction/restricted fragment length polymorphism (PCR/RFLP) assay.Methods: Gastric biopsies obtained from 100 dyspeptic patients who consecutively attended at Cairo University Hospital during the period from January to November 2013 were subjected to PCR/RFLP in order to detect the point mutations at domain V of the H. pylori 23S rRNA associated with clarithromycin resistance. The PCR amplicon of the 23S H. pylori rRNA is restricted with MboII for detection of A2142G mutation and with BsaI for A2143G mutation.Results: The prevalence of H. pylori infection among 100 patients was 70%; clarithromycin resistance was detected in 39/70 (57.7%) of positive H. pylori isolates. Occurrence of 23S rRNA A2142G mutations resulted in two DNA fragments (418 and 350 bp) by PCR-RFLP; on the other hand, no A2143G mutations were detected.Conclusions: The high prevalence of clarithromycin resistance (57.7%) caused by A2142G mutations at domain V of the H. pylori 23S rRNA may mandate changing of the standard clarithromycin-containing triple therapy. The PCR/RFLP assay was a rapid and accurate method for molecular detection of H. pylori infection in addition to determination of different nucleotide mutations causing clarithromycin resistance.

GENETIC MUTATIONS AFFECTING THE FIRST LINE ERADICATION THERAPY OF Helicobacter pylori-INFECTED EGYPTIAN PATIENTS.

SUMMARYIntroduction: Several genetic mutations affect the first-line triple therapy for Helicobacter pylori. We aimed to study the most common genetic mutations affecting the metronidazole and clarithromycin therapy for H. pylori-infected Egyptian patients.Patients and Methods: In our study, we included 100 successive dyspeptic patients scheduled for diagnosis through upper gastroscopy at Cairo's University Hospital, Egypt. Gastric biopsies were tested for the presence of H. pylori by detection of the 16S rRNA gene. Positive biopsies were further studied for the presence of the rdxA gene deletion by Polymerase Chain Reaction (PCR), while clarithromycin resistance was investigated by the presence of nucleotide substitutions within H. pylori 23S rRNA V domain using MboII and BsaI to carry out a Restricted Fragment Length Polymorphism (RFLP) assay.Results: Among 70 H. pylori positive biopsies, the rdxA gene deletion was detected in 44/70 (62.9%) samples, while predominance of the A2142G mutations within the H. pylori 23S rRNA V domain was evidenced in 39/70 (55.7%) of the positive H. pylori cases. No statistically significant difference was found between the presence of gene mutations and different factors such as patients 'age, gender, geographic distribution, symptoms and endoscopic findings.Conclusion: Infection with mutated H. pylori strains is considerably high, a finding that imposes care in the use of the triple therapy to treat H. pylori in Egypt, since the guidelines recommend to abandon the standard triple therapy when the primary clarithromycin resistance rate is over 20%1.

A Comparison between Hybrid Therapy and Standard Triple Therapy for Helicobacter pylori Eradication in Patients with Uremia: A Randomized Clinical Trial.

BACKGROUND The prevalence of peptic ulcer disease in hemodialysis patients is more than the general population. They are also more prone to complications including upper gastrointestinal bleeding. The aim of this study was to compare the efficacy of 14 days hybrid regimen with 14 days triple therapy for Helicobacter pylori (H. pylori ) eradication in hemodialysis patients. METHODS Forty hemodialysis patients with naïve H.pylori infection were randomized to receive either hybrid regimen (pantoprazole 40 mg + amoxicillin 500 mg, both twice a day during the first 7 days, followed by pantoprazole 40 mg + amoxicillin 500 mg + clarithromycin 500 mg + tinidazole 500 mg, all twice a day, for the second 7 days, or standard triple therapy including pantoprazole 40 mg, clarithromycin 500 mg, and amoxicillin 500 mg, all twice a day for 14 days. H.pylori eradication was assessed by fecal H.pylori antigen test 8 weeks after the treatment. RESULTS All the patients completed the study. According to both intention to treat and per-protocol analyses, H.pylori eradication rates were 100% (95% confidence interval (CI): 100) in those who received hybrid therapy and 70% (95% CI: 69.4 – 70.8) in those who were treated by standard triple therapy (p=0.02). Severe adverse effects were not reported by any patient; however, mild adverse effects were more frequent in those who received standard triple therapy (p<0.05). CONCLUSION Hybrid regimen could achieve ideal H.pylori eradication rates with low rates of adverse effects.

Sitafloxacin-Based Therapy for

The success of standard triple therapy for Helicobacter pylori has been decreasing due to the increased prevalence of antibiotic resistance. Various