Triple Therapy For Eradication Research Articles

Prevalence of Helicobacter pylori infection and effectiveness of first-line triple eradication therapy among dyspeptic patients at hospitals in Hawassa City, Ethiopia: a cross-sectional follow-up study

BackgroundDyspepsia is a common gastrointestinal illness sometimes associated with Helicobacter pylori (H. pylori) infection. Screening and eradicating the bacterium reduces the risk of infection-related complications. The aim of this study was to determine the magnitude of H. pylori infection among dyspeptic patients and the effectiveness of triple eradication therapy at hospitals in Hawassa city, Ethiopia.ResultsThe prevalence of H. pylori infection was 48.5%. The H. pylori eradication rate using first-line triple therapy was 83.8%. Eradication therapy failure is associated with previous exposure compared to no exposure (AOR: 4.8, 95% CI: 1.37–10.97), a regimen for 10-days compared to 14-days (AOR: 4.05, 95% CI: 1.42–11.55), and self-reported side effects compared to no report (AOR: 2.5, 95% CI: 1.12–5.97). Based on Morisky-eight scale 230 (79.0%) patients were adherent to their triple therapy. Participants with no reports of adverse effects showed increased odds of adherence to triple therapy compared to those who had reports (AOR = 2.45, 95% CI: 1.29–4.62).ConclusionsThis study demonstrated that about half of adult dyspeptic patients were infected with H. pylori, and moderate eradication was observed. Factors such as previous history of eradication therapy, duration of the eradication regimen, and perception of potential adverse effects are associated with eradication rate and should be considered during the initiation of eradication therapy.

Bismuth add-on improves the efficacy of 2-week tegoprazan-based triple therapy for first-line Helicobacter pylori eradication: a real-world evidence study

ABSTRACT Background This study aimed to investigate the efficacy of bismuth added to a 2-week triple therapy consisting of tegoprazan (TPZ), amoxicillin, and clarithromycin for first-line Helicobacter pylori eradication. Research design and methods We reviewed the retrospective data of patients who received a 2-week TPZ-based triple therapy with or without 300 mg bismuth twice daily. The primary endpoint was the H. pylori eradication rate of adding bismuth to the TPZ-based triple regimen (TAC-B group), compared to no bismuth added (TAC group). Results In total, 306 and 256 patients were included in the intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The eradication success rates were significantly higher in the TAC-B group than in the TAC group (ITT, 82.9% vs. 71.8%, p = 0.029; PP, 95.8% vs. 87.5%, p = 0.027, respectively). The adherence rate to the eradication regimen was 100% in the TAC-B group and 97.0% in the TAC group. The adverse drug event rate in the TAC-B group was comparable to that in the TAC group (29.2% vs. 27.3%, p = 0.742). No use of bismuth was significantly associated with eradication failure (p = 0.038). Conclusions The bismuth add-on increased the first-line H. pylori eradication rate of 2-week TPZ-based triple therapy. Clinical trial registration www.clinicaltrials.gov identifier is NCT05453994.

14-day tailored PCR-guided triple therapy versus 14-day non-Bismuth concomitant quadruple therapy for Helicobacter pylori eradication: A multicenter, open-label randomized noninferiority controlled trial.

The systematic use of susceptibility testing and tailored first-line treatment for Helicobacter pylori eradication has yet to be established. To compare 14-day tailored PCR-guided triple therapy to 14-day non-Bismuth concomitant quadruple therapy for first-line Helicobacter pylori eradication. We performed a multicenter, parallel-group, randomized noninferiority controlled trial. Naive adult patients with Helicobacter pylori infection were treated with 14-day tailored PCR-guided triple therapy (esomeprazole 40 mg and amoxicillin 1000 mg b.d. plus clarithromycin 500 mg or levofloxacin 500 mg b.d. according to clarithromycin susceptibility) or 14-day non-Bismuth concomitant quadruple therapy (esomeprazole 40 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and metronidazole 500 mg b.d.). The primary endpoint was H. pylori eradication. We screened 991 patients for eligibility and randomized 241 patients. The first-line eradication rate was 99.2% in the tailored PCR-guided group and 95.9% in the control group (ITT population; absolute difference of +3.30%, with a lower bound of CI at -0.68%). Both first-line therapies were well tolerated, with a formally significant difference in favor of the tailored PCR-guided group (61.4% vs. 41.2%, p = 0.003). Economic analyses revealed a lower cost of the tailored PCR-guided arm, with a 92% chance of being jointly more effective and less expensive than the control arm in the ITT population. In a country with a high level of clarithromycin resistance, the results of our study demonstrated the noninferiority of 14-day tailored PCR-guided triple therapy as a first-line H. pylori eradication therapy compared to 14-day non-Bismuth quadruple therapy (ClinicalTrials.gov NCT02576236).

Correlation of iron deficiency indexes with Eradication and Recurrence of Helicobacter Pylori Infection in Children.

To explore the correlation of iron deficiency (ID) indexes with eradication and recurrence of Helicobacter pylori (Hp) infection in children. This is a clinical comparative study. One hundred and twenty-six children who were first diagnosed as Hp infection in Baoding Children's Hospital (Hp infection group); and the control group included 200 children without Helicobacter Pylori infection (negative stool Hp antigen test and/or 13C-urea breath test) in local region at the same time from January 2020 to January 2022. Enrolled children were subjected to routine blood test, serum ferritin (SF), serum iron (SI) and total iron binding capacity (TIBC) detection. Meanwhile, children with Hp infection were given triple therapy for eradication and followed up for one year. The levels of SI, SF and Hb in non-eradication group were lower than those in eradication group (P<0.05); while TIBC level in the former group was higher than that in the latter group (P<0.05). Furthermore, SF level in the recurrence group was lower than that in the non-recurrence group (P<0.05). While there was no significant difference in Hb, SI and TIBC levels between the recurrence group and the non-recurrence group (P>0.05). Low level of SF may be a risk factor for difficulty in eradication and recurrence after eradication in children with Hp infection. Meanwhile, low levels of Hb and SI are influential factors for difficulty in eradication in children with Hp infection.

The significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus and for Helicobacter pylori survival

Aim: This study aims to determine the significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus (T2DM) and Helicobacter pylori (H. pylori)-associated upper gastrointestinal tract pathology as well as for H. pylori survival. Methods: A prospective randomized study with the participation of 180 patients (87 men and 93 women) with H. pylori-associated upper gastrointestinal pathology was carried out. Ninety of these patients were with T2DM and 90 were without diabetes mellitus (DM). The patients were divided into 4 groups of 45 patients: the group 1 included non-diabetic patients treated with the classical triple eradication scheme; the group 2 included patients with T2DM treated with the classical triple eradication scheme; the group 3 included non-diabetic patients treated with bismuth quadro-therapy; the group 4 included patients with T2DM treated with bismuth quadro-therapy. The presence of H. pylori and evaluation of eradication efficacy was carried out using the Helix breath test. Results: The effectiveness of 1st line anti-Helicobacter therapy was higher (88.2%) in patients without diabetes in comparison with the group of patients with concomitant T2DM (74.7%). The efficacy of classical triple eradication therapy in patients with concomitant T2DM was 69.1%, and quadro-therapy was 80.5%. There was significantly lower effectiveness (P &lt; 0.017) of eradication therapy in patients with T2DM and glycated hemoglobin (HbA1c) level ≥ 7.0% as compared with the group of patients in whom the target (≤ 6.5%) level of HbA1c was achieved. Conclusions: Chronic hyperglycemia has a favorable effect on the viability of H. pylori bacteria in patients with T2DM. A hypothesis explaining the reduced efficacy of eradication therapy in patients with hyperglycemia has been proposed.

Vonoprazan-based Dual and Triple Therapy for Helicobacter pylori Eradication

Vonoprazan-based Dual and Triple Therapy for Helicobacter pylori Eradication

Triple therapy for Helicobacter pylori eradication and the risk of hypoglycemia in patients with diabetes: a population-based cohort study

The incidence of type 2 diabetes mellitus has risen globally, from 108 million cases in 1980 to 422 million cases in 2014. Although controlling glycemic levels in patients with diabetes is crucial, insulin and sulfonylureas can cause hypoglycemic episodes and even potentially fatal events such as comas, seizures, life-threatening arrhythmias, and myocardial infarctions. Several antibiotics have been documented to cause hypoglycemic episodes; the use of antibiotics along with insulin or sulfonylureas might further increase the risk of hypoglycemia. Therefore, researchers must determine which antibiotics carry a risk of inducing severe hypoglycemic events. The prevalence of H. pylori infection remains high in most countries, and the infection is often treated with triple therapy involving amoxicillin, clarithromycin, and a proton pump inhibitor (PPI). Several case reports have reported that hypoglycemia can occur when used with patients who also take diabetes medication. Therefore, we hypothesized that patients with diabetes have an increased risk of hypoglycemic episodes when being treated with triple therapy for H. pylori infection. By analyzing medical records from Taiwan’s National Health Insurance Research Database, we found a significant association between hypoglycemia and triple therapy treatment for diabetic patients with peptic ulcer disease. Prescribing triple therapy to patients with diabetes and peptic ulcers significantly increased the risk of a hypoglycemic episode (adjusted odds ratio [aOR] = 1.75, 95% confidence interval [CI]: 1.64 to 1.88, P < 0.001). Similarly, the highest aOR (5.77, 95% CI 4.82 to 6.92) was found in patients with diabetes and peptic ulcers who had hypoglycemic episodes within 30 days after triple therapy treatment. Many patients with diabetes require H.pylori eradication for peptic ulcer treatment, and vigilance toward the risk of hypoglycemia in this population is thus necessary.

Application of N-Acetyl-Glucosaminil-N-Acetyl-Muramyl Dipeptide during Triple Component Anti-Helicobacter Pylori Therapy in the Period of Coronavirus Infection COVID-19

Aim: evaluation of the incidence of COVID-19 infection after three-component H. pylori eradication therapy while taking N-acetyl-glucosaminyl-N-acetyl-muramyl dipeptide (GMDP).Materials and methods. A prospective randomized comparative clinical study was carried out. The study included 208 patients (147 men, 61 women; mean age — 48.1 ± 14.5 years) with duodenal ulcer associated with Helicobacter pylori (H. pylori) who underwent eradication therapy. H. pylori in the gastric mucosa was detected by a morphological method and a rapid urease test before treatment and 6-8 weeks after the end of treatment and the withdrawal of all drugs. Patients were divided into three groups according to treatment protocols: omeprazole 0.04 g/day, clarithromycin 1 g/day, amoxicillin 2 g/day (OСA; n = 103); omeprazole 0.04 g/day, clarithromycin 1 g/day, amoxicillin 2 g/day + GMDP 0.001 g/day (OCAL1; n = 61) or 0.01 g/day (OCAL10; n = 44) for 10 days. Detection of SARS-CoV-2 RNA by PCR was carried out from April 2020 to April 2022. Tracking completeness was 96.6 %.Results. The frequency of H. pylori eradication depending on “intention to treat” (ITT) and “per protocol” (PP): OCA — 79 % (95 % CI: 71-87) and 83 % (95 % CI: 75-91); OCAL1 — 95 % (95 % CI: 88-100) and 97 % (95 % CI: 92-100); OCAL10 — 96 % (95 % CI: 89-100) and 98 % (95 % CI: 93-100) respectively. The frequency of adverse reactions depending on ITT and PP: OCA — 24 % (95 % CI: 16-33) and 26 % (95 % CI: 17-35); OCAL1 — 2 % (95 % CI: 0.01-8) and 2 % (95 % CI: 0.01-8); OCAL10 — 2 % (95 % CI: 0.01-7) and 2 % (95 % CI: 0.01-7). The incidence of COVID-19 infection depending on ITT and PP: OCA — 9 % (95 % CI: 3-14) and 9 % (95 % CI: 3-15); OCAL1 + OCAL10 — 1 % (95 % CI: 0.003-1.9) and 1 % (95 % CI: 0.001-2.9), respectively.Conclusions. In H. pylori-infected patients, GMDP (an immunomodulator based on L. bulgaricus) at a dose of 1-10 mg/day, during a 10-day triple eradication therapy, allows a significant (p &lt; 0.05) increase in the frequency of H. pylori eradication and reduce the incidence of adverse reactions compared with a 10-day protocol without adjuvant therapy with GMDP. There was a significant (p &lt; 0.05) decrease in the incidence of COVID-19 infection after H. pylori eradication therapy with GMDP.

Determination of Helicobacter pylori resistance to clarithromycin in biopsy samples of gastric mucosa using TaqMan® MGB probes

Objective. To study primary resistance of H. pylori to clarithromycin in residents of Gomel region by real-time polymerase chain reaction (PCR RT) using TaqMan® MGB probes.Materials and methods. The study included 184 patients diagnosed with gastritis and duodenitis, K29, median age 48.5 years (25% and 75% were 37 and 61 years old). According to the patients’ questionnaires, no clarithromycin-based eradication therapy was administered. To determine the resistance of H. pylori to clarithromycin, a PCR RV method using TagMan® MGB probes was used.Results. All 184 tested DNA samples were positive for the Rnase P gene (ICS) and were considered in further analysis (Ct, HEX 20.20-34.14). DNA from the cagH gene (Ct, FAM 21.26-33.04), indicating infection with the bacterium, was confirmed in 152 samples (82.6%). DNA from the 23SrRNA gene (point mutations A2142G and A2143G) was detected in 16 of 152 DNA samples 10.5 % (Ct, Hex 20.24-31.17). The positive control samples had characteristic curve growth in the corresponding detection channels; no curve growth was observed in the negative samples.Conclusion. The primary resistance of H. pylori to clarithromycin in the residents of Gomel region was 10.5%, and the use of triple first-line eradication therapy, including PPIs, amoxicillin and clarithromycin, as empirical in this region is consistent with the Maastricht III-VI recommendations and Decree of the Ministry of Health of the Republic of Belarus of 01.06.2017 № 54: clinical protocol “Diagnosis and treatment of patients with digestive diseases.” The use of PCR RT using TaqMan® MGB probes is justified to determine the resistance of H. pylori to clarithromycin, to prescribe individualized treatment and to evaluate the effectiveness of eradication regimens.

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

Combination of gastroprotectors and probiotics in the eradication of H. pylori infection: results of a randomized comparative clinical trial

Objective. To compare efficacy and safety of 14-day triple eradication therapy with the addition of methylmethionine sulfonium chloride and a probiotic complex and 14-day triple eradication therapy boosted with bismuth tripotassium dicitrate and a probiotic complex in a prospective comparative randomized clinical trial. Materials and Methods. A total of 70 patients with confirmed H. pylori infection were enrolled into the study. The first group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 14 days, methylmethionine sulfonium chloride 300 mg once a day for 1 month, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. The second group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg 2 bid, amoxicillin 1000 mg 2 bid and bismuth tripotassium dicitrate 240 mg 2 bid for 14 days, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. Eradication of H. pylori was assessed using stool antigen test. Results. Eradication rates for the first and second groups in the intent-to-treat (ITT) population were 77.1% and 88.6% (p = 0.205), respectively. In the per-protocol (PP) population, eradication rates were 81.8% and 96.9% (p = 0.051), respectively. Adverse events were reported in 34.3% of patients in the first group and 34.3% of patients in the second group (p = 1). Conclusions. 14-day standard triple therapy boosted with bismuth tripotassium dicitrate and a probiotic complex demonstrates high efficacy and safety profile, and therefore can be recommended as first-line therapy for H. pylori infection in adults.

Evaluation of Stool Antigen Test in patients infected by Helicobacter pylori after Eradication Therapy

Noninvasive tests for Helicobacter pylori are important in primary care, both for initial diagnosis of H. pylori infection and for confirmation of eradication. The objective of the present study was to evaluate the effectiveness of a stool antigen test after therapy. We studied 30 patients (16 males &amp; 14 females) infected with H. pylori at the outpatient clinic in Azady teaching hospital. After the completion of triple eradication therapy, all patients were subjected to the examination of the stool antigen test. Of the total 30 cases, there were 23 cases with negative stool Ag test after therapy. All seven cases without therapy were positive stool, Ag. The result of the stool antigen test after therapy was 76% (negative in 23 patients, false-negative in 7 patients). We concluded that a negative result on stool antigen testing after completion of therapy recognizes patients in whom the eradication of H. pylori was successful.

Efficacy and Tolerability of 14-Day Tegoprazan- versus Rabeprazole-Based Triple Therapy for Eradication of Helicobacter pylori: A Real-World Evidence Study.

Tegoprazan, a new, fast, and strong potassium-competitive acid blocker, has been approved for the treatment of gastric acid-related diseases in Korea. However, real-world clinical data regarding this drug are scarce. We aimed to compare the Helicobacter pylori eradication rates of tegoprazan- and rabeprazole-based triple therapy. We retrospectively reviewed data from patients who received first-line treatment for H. pylori infection using tegoprazan- or rabeprazole-based triple therapy for 2 weeks (50 mg tegoprazan or 20 mg rabeprazole+1,000 mg amoxicillin+500 mg clarithromycin twice daily). The primary endpoint was the eradication rate as determined by intention-to-treat analysis. Of the 677 patients included in our study, 344 and 333 received tegoprazan-based and rabeprazole-based triple therapy, respectively. The eradication rate from intention-to-treat analysis was 76.7% (95% confidence interval [CI], 72.1% to 81.0%) for tegoprazan-based triple therapy and 75.4% (95% CI, 70.5% to 79.8%) for rabeprazole-based triple therapy. There was no significant difference in the eradication rates between the two groups (p>0.999). Per-protocol analysis also revealed no significant difference between the eradication rates of the two groups (tegoprazan 83.4% [95% CI, 79.0% to 87.2%] vs rabeprazole 83.5% [79.0% to 87.4%], p>0.999). Furthermore, there was no significant difference in adverse event rates between the two groups (tegoprazan, 27.6%; rabeprazole, 25.8%; p=0.604). The eradication rate of tegoprazan-based triple therapy was similar to that of rabeprazole-based triple therapy. Further studies on the dose-escalation effect of tegoprazan for H. pylori eradication and the efficacy of tegoprazan in regimens other than conventional triple therapy are needed.

Comparative Efficacy of 14-Day Tegoprazan-Based Triple vs. 10-Day Tegoprazan-Based Concomitant Therapy for Helicobacter pylori Eradication.

Tegoprazan, a novel potassium-competitive acid blocker, is currently available for the treatment of Helicobacter pylori infection. We compared the efficacies of tegoprazan-based triple and concomitant therapies in a real-world practice. Data of patients treated with a 14-day tegoprazan-based triple therapy (50 mg of tegoprazan + 1000 mg of amoxicillin + 500 mg of clarithromycin twice daily) or 10-day tegoprazan-based concomitant therapy (50 mg of tegoprazan + 1000 mg of amoxicillin + 500 mg of clarithromycin + 500 mg of metronidazole twice daily) were retrospectively reviewed. Primary endpoint was eradication rate in the intention-to-treat (ITT) population. Of the 928 included patients, 551 and 377 were treated with triple and concomitant therapies, respectively. Eradication rate from ITT analysis was 76.4% (95% confidence interval [CI], 72.7−79.8%) in the triple therapy group and 85.9% (95% CI, 82.2−89.2%) in the concomitant therapy group (p < 0.001). Eradication rate in the per-protocol analysis was also higher in the concomitant therapy group than in the triple therapy group (triple vs. concomitant therapy: 84.5% [81.1−87.5%] vs. 91.1% [87.8−93.8%]). Overall adverse event rate was 29.0% in the triple therapy group and 45.9% in the concomitant therapy group (p < 0.001). Adherence rate was similar between the two groups (triple vs. concomitant therapy: 90.0 vs. 92.6%, p = 0.180). Overall, the 10-day tegoprazan-based concomitant therapy had superior efficacy than the 14-day tegoprazan-based triple therapy for H. pylori eradication. Although concomitant therapy showed common adverse events, adherence was comparable between the two therapies.

Efficacy and Safety of Polaprezinc-Based Therapy versus the Standard Triple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Helicobacter pylori (H. pylori) is the most prevalent etiology of gastritis worldwide. H. pylori management depends mainly on antibiotics, especially the triple therapy formed of clarithromycin, amoxicillin, and proton pump inhibitors. Lately, many antibiotic-resistant strains have emerged, leading to a decrease in the eradication rates of H. pylori. Polaprezinc (PZN), a mucosal protective zinc-L-carnosine complex, may be a non-antibiotic agent to treat H. pylori without the risk of resistance. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of a PZN-based regimen for the eradication of H. pylori. This study used a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, PubMed, and Google Scholar until 25 July 2022. We used the odds ratio (OR) for dichotomous outcomes presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022349231. We included 3 trials with a total of 396 participants who were randomized to either PZN plus triple therapy (n = 199) or triple therapy alone (control) (n = 197). Pooled OR found a statistical difference favoring the PZN arm in the intention to treat and per protocol H. pylori eradication rates (OR: 2.01 with 95% CI [1.27, 3.21], p = 0.003) and (OR: 2.65 with 95% CI [1.55, 4.54], p = 0.0004), respectively. We found no statistical difference between the two groups regarding the total adverse events (OR: 1.06 with 95% CI [0.55, 2.06], p = 0.85). PZN, when added to the triple therapy, yielded a better effect concerning the eradication rates of H. pylori with no difference in adverse event rates, and thus can be considered a valuable adjuvant for the management of H. pylori. However, the evidence is still scarce, and larger trials are needed to confirm or refute our findings.

Quadruple therapies are superior to standard triple therapy for Helicobacter pylori first-line eradication in Chile

Helicobacter pylori infection affects approximately 70% of the Chilean population. It is a public health problem whose eradication treatment is part of the explicit health guarantees in Chile. Characterize the most widely used H. pylori first-line eradication therapies in our environment and evaluate their efficacy. A retrospective observational study was carried out where, in patients with certified H. pylori infection, the eradication therapy indicated by the treating physician, its efficacy, adherence and adverse effects, in addition to the eradication certification method used, were evaluated. 242 patients and 4 main therapies were analyzed: standard triple therapy, dual therapy, concomitant therapy, and bismuth quadruple therapy. Eradication rates of 81.9% (95% CI 74.44–87.63), 88.5% (95% CI 73.13–95.67), 93.7% (95% CI 78.07–98.44) and 97.6% (95% CI 84.81–99.67) were observed respectively, with concomitant therapy (RR: 1.14; 95% CI 1.01–1.29; p = 0.028) and quadruple therapy with bismuth (RR: 1.19; 95% CI 1.09–1.31; p < 0.001) being significantly more effective than standard triple therapy. Regarding the rate of reported adverse effects, it was 58.5% (95% CI 50.66–65.92), 35.4% (95% CI 24.6–48.11), 22.9% (95% CI 81–37.14) and 63.4% (95% CI 47.8–76.64), having the dual and concomitant therapy significantly fewer adverse effects compared with standard therapy. Quadruple therapies are superior to standard triple therapy and should be considered as first-line treatment in Chile. Dual therapy is promising. More studies will be required to determine which therapies are most cost-effective. La infección por Helicobacter pylori afecta aproximadamente al 70% de la población chilena. Es un problema de salud pública cuyo tratamiento de erradicación forma parte de políticas públicas en Chile. Caracterizar los esquemas de erradicación de primera línea de H. pylori más utilizados en nuestro medio y evaluar su eficacia. Se realizó un estudio observacional retrospectivo donde, en pacientes con infección por H. pylori certificada, se evaluó el esquema de erradicación indicado por el médico tratante, su eficacia, adherencia y efectos adversos. Se analizaron 242 pacientes y 4 esquemas de erradicación; terapia triple estándar, terapia dual, concomitante y cuadriterapia con bismuto. Se observaron tasas de erradicación de 81,9% (IC 95% 74,44–87,63), 88,5% (IC 95% 73,13–95,67), 93,7% (IC 95% 78,07–98,44) y 97,6% (IC 95% 84,81–99,67) respectivamente, siendo más eficaces la terapia concomitante (RR: 1,14; IC 95% 1,01–1,29; p = 0,028) y cuadriterapia con bismuto (RR: 1,19; IC 95% 1,09–1,31; p < 0,001) que la triple terapia estándar. La tasa de efectos adversos reportados fue de 58,5% (IC 95% 50,66–65,92), 35,4% (IC 95% 24,6–48,11), 22,9% (IC 95% 11,81–37,14) y 63,4% (IC 95% 47,8–76,64), para la terapia triple estándar, dual, concomitante, y cuádruple con bismuto, respectivamente. La terapia dual y concomitante tuvieron menos efectos adversos en comparación con la terapia estándar. Las cuadriterapias son superiores a la triple terapia estándar por lo que deberían ser consideradas como tratamiento de primera línea en Chile. La terapia dual es promisoria. Más estudios serán requeridos para determinar qué esquemas son más costo-efectivos.

Comparison of Efficacy of Conventional Triple Therapy and Non Bismuth Quadruple Therapy for Helicobacter Pylori Eradication

Objective: To compare the efficacy of conventional triple therapy and non bismuth quadruple therapy for helicobacter pylori eradication. Setting: Gastroenterology Department, Lady Reading Hospital Peshawar. Study Design: Randomized control trial. Duration: 6 months 15th August, 2018 to 15th February 2019. Materials and Methods: In this study a total of 111 patients were observed. Patients were put in two groups, group A triple Helicobacter pylori eradication therapy and group B non-bismuth quadruple Helicobacter pylori eradication therapy. Randomization of patients to either treatment group was done through lottery method. All patients were worked up with detailed history and clinical examination to look for any known allergy to drugs used in this study, to document any comorbidity and to exclude alarm features, baseline investigations including complete blood count, Random blood sugar, liver function tests and renal function tests. H pylori stool antigen was reported from Lady Reading Hospital laboratory at time of inclusion and four weeks after completion of therapy. The purpose and benefits of study was explained to patients and written consent for participation in study was obtained. Patients were asked on follow up about adherence to the treatment. Results: In this study mean age in Group A was 44 years with SD ± 2.77. Whereas mean age in Group B was 42 years with SD ± 3.12. In Group A 55% patients were male and 45% patients were female. Where as in Group B 58% patients were male and 42% patients were female. More over Group A (triple Helicobacter pylori eradication therapy) was effective in 75% patients. Where as Group B (non-bismuth quadruple Helicobacter pylori eradication therapy) was effective in 94% patients and was not effective in 6% patients. Conclusion: Our study concludes that non bismuth quadruple therapy is more effective than triple therapy in the treatment of Helicobacter pylori eradication. Keywords: Conventional triple therapy, Non-bismuth quadruple therapy, Helicobacter pylori eradication

Innovative pH-dependent approach for electrochemical determination of a triple eradication therapy targeting H. Pylori infection in pharmaceutical formulation and human plasma sample: Modified electrode with Prussian blue analogue decorated multi-walled carbon nanotubes (PbA@MWCNT)

In the present study, a sensitive and cost-effective voltammetric method was developed, optimized and applied for assessment of a new combination of a triple therapy treatment that contain tinidazole (TZ), clarithromycin (CLR) and lansoprazole (LAN) depending on different pH effect. The study was developed using electrode of carbon paste improved by Prussian blue analogue nanoparticles in addition to multi-walled carbon nanotubes (PbA-NPs/MWCNT/CPE). The characterization and morphology of the nanoparticles composite was studied for the adopted electrode by X-ray diffraction (XRD) patterns, scanning electron microscope (SEM) and Transmission Electron Microscope (TEM). Effect of different electrodes and content of PbA-NPs on the voltammetric performance of the three drugs were assessed. Differential pulse voltammetry (DPV) was estimated and linear correlations were then obtained in the range of 0.01–0.9, 1.0–10.0 and 0.5–12.0 µg/mL for LAN, CLR and TZ, respectively. The optimized method has been validated as per the ICH guidelines and found to be appropriate for the routine quality control of the studied drugs in their pharmaceutical formulation in addition to spiked human plasma. Consequently, the proposed method definitely provides an efficient, beneficial, reliable and cost-effective tool for estimation of the cited active pharmaceutical ingredients.

A multi-center, randomized controlled study on the effect of Saccharomyces boulardii combined with triple therapy for the initial eradication of Helicobacter pylori infection

Objective: To assess the efficacy and safety of Saccharomyces boulardii (S. boulardii) in combination with triple therapy as a first-line regimen for the eradication of Helicobacter pylori (H. pylori) in non-ulcer dyspepsia (NUD) patients. Methods: A total of 497 Helicobacter pylori-positive patients who underwent gastroscopy and diagnosed with NUD were enrolled from June 2018 to January 2020 in 9 medical centers across China. Participants were segmentedly randomly divided into 3 groups. Patients in group A received S. boulardii for 14 days and triple therapy for 10 days, while patients in group B received bismuth quadruple group for 10 days, and patients in group C received triple therapy for 10 days. The H. pylori status was determined by the 13C-urea breath test on the 44th day of the treatment. Symptom improvement and adverse reactions were assessed on the 14th and 44th day. Results: There were 229 males and 268 females in all 497 patients enrolled. They were aged 18-69 (46.1±11.8) years and 472 of them (158 cases in group A, 159 cases in group B, and 155 cases in group C) completed the trial. The intention-to-treat (ITT) eradication rates in patients in patients A, B and C were 77.8% (126/162), 80.1% (137/171) and 65.2% (107/164) respectively, and per protocol-based (PP) eradication rates were 79.7% (126/158), 86.2% (137/159) and 69.0% (107/155) respectively. The differences were statistically significant in ITT and PP analysis among 3 groups (ITT: χ²=11.14, P<0.01; PP: χ²=13.86, P<0.01). There was no significant difference between eradication rates of two quadruple therapys(all P>0.05), but both of them were significantly higher than that of standard triple therapy (both P<0.05). Statistics revealed that both quadruple therapys led to significantly higher symptom improvement of belching compared with that of standard triple therapy in day 14 (P<0.05). The relief of abdominal distension and belching symptom scores of group A were significantly higher than those of group C in day 44(all P<0.05). There was no serious adverse event reported. The incidence of diarrhea in group A was significantly lower than those in the other two groups (both P<0.05). Conclusions: The combination of S. boulardii and triple therapy can achieve a better eradication effect on H. pylori infection with NUD, and has advantages in symptom relief and safety.