Triple Therapy For Eradication Research Articles

The role of silent helicobacter pylori infection in intragastric ulcers induced by balloon insertion used for management of obesity

BackgroundObesity represents one of the common medical disorders that carries a high risk of morbidity and mortality. Insertion of intragastric balloon is one of the recently introduced lines of treatment of obesity. It allows patients to sense abdominal fullness and reduce their food intake. However, gastric ulceration may be a serious adverse effect that may be associated with intragastric balloon insertion. AimTo assess the role of silent helicobacter pylori infection in intragastric balloon-induced ulcers and to explore the possible methods for amelioration of this effect. MethodsThirty patients were divided into 2 equal groups; one of them received triple therapy for helicobacter pylori eradication and the other group received placebo treatment. Then, they underwent intragastric balloon insertion. After removal of the balloon, gastroscopy was performed to evaluate the gastric mucosal lesions, if present. ResultsThere was significant decrease in the incidence of gastric erosions and ulcerations in the group that received triple therapy for helicobacter pylori eradication compared to the group that received placebo treatment. ConclusionEradication of silent helicobacter pylori infection may represent a promising hope to decrease the incidence and improve symptoms of gastric erosions and ulceration that may be associated with intragastric balloon insertion.

Evaluation of the efficacy and safety of the hybrid scheme for eradication therapy of Helicobacter pylori infection.

The aim is to conduct a comprehensive comparative study of the efficacy and safety of the hybrid scheme of eradication therapy (ET) in patients with peptic ulcer of the stomach or duodenum associated with Helicobacter pylori. Materials and methods. In a prospective, randomized comparative study, 180 patients were divided into three equal groups of 60 people, depending on the prescribed 10-day ET regimen. Group 1 - the standard triple scheme (omeprazole, amoxicillin and clarithromycin); group 2 - four-component therapy with preparations of bismuth (omeprazole, tetracycline, metronidazole, bismuth tricalium dicitrate); group 3 - hybrid scheme (first 5 days: omeprazole and amoxicillin, the next 5 days: omeprazole, amoxicillin, clarithromycin, metronidazole). The effectiveness of ET was determined with the help of a breath test a month after the end of therapy. Adverse events were recorded by patients in specially developed diaries. Pharmacoeconomic analysis was carried out using the "cost-effectiveness" method with calculation of the CER coefficient. Results and discussion. The effectiveness of standard triple therapy was 73.3% (ITT), 75.9% (PP); four-component therapy with bismuth preparations - 78.3% (ITT), 82.4% (PP); hybrid scheme - 85% (ITT), 91% (PP). Hybrid therapy proved to be significantly more effective than standard triple therapy with a odds ratio (OR) of 3.25; 95% confidence interval (CI) 1.08-9.73 (p=0.043, χ2=4.75, p-level=0.029298). The incidence of adverse events with the use of triple, four-component and hybrid ET regimens was 15; 18.3 and 28.3% respectively. The OR of at least one adverse event in patients receiving a hybrid ET regimen compared with triple therapy was 2.24 (95% CI 0.91-5.53, p=0.0823, χ2=3.14, p-level=0.076394), and compared with the four-component therapy - 1.76 (95% CI 0.74-4.17, p=0.2804, χ2=1.68, p-level=0.194924). According to the results of the pharmacoeconomic analysis, the most profitable from an economic point of view was a hybrid ET scheme with a CER of 20.1. The conclusion. Hybrid therapy showed the greatest effectiveness in comparison with the triple and four-component ET regimens, however, the incidence of side effects in patients receiving the hybrid ET scheme was higher, although it remained within the acceptable level for use in clinical practice. Pharmacoeconomic analysis also showed the advisability of designating a hybrid ET scheme. The obtained data allow to draw a conclusion about the necessity of further study of the efficiency and safety of the hybrid ET scheme.

Efficacy and safety of the use of rebamipide in the scheme of triple eradication therapy of Helicobacter pylori infection: a prospective randomized comparative study.

To evaluate the effectiveness and safety of the use of rebamipide as part of the triple eradication therapy (ET) scheme of Helicobacter pylori infection. A prospective, randomized comparative study included 94 patients with uncomplicated H. pylori-associated stomach / duodenal ulcer. In the process of randomization, patients are divided into three groups depending on the intended therapy. The first group (n=36) received a classical triple scheme of the first-line ET (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day) for 10 days. Patients of the second group (n=33) were assigned a classical triple scheme of ET with the inclusion of rebamipide (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, rebamipide 100 mg 3 times a day day) for 10 days. Patients of the third group (n=25) were assigned a classical triple scheme of ET with the inclusion of rebamipide (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, rebamipide 100 mg 3 times a day) in for 10 days, with the prolongation of the administration of rebamipide for the next 20 days. The effectiveness of ET was determined by the respiratory test after 6 weeks after the end of treatment. Adverse events were recorded by patients in specially developed diaries. All patients with gastric ulcer at the 6th week underwent a histological examination of the biopsy specimens of the antrum and the body of the stomach, assessing the inflammatory activity of the process on a point system in accordance with the updated Sydney system. Efficiency of H. pylori eradication in the first group was 77.7% (ITT), 82.3% (PP), in the second group - 81.8% (ITT), 84.4% (PP), and in the third group - 84% (ITT), 87.5% (PP). The use of rebamipide in the triple ET regimen was associated with an increase in H. pylori eradication efficiency, both with simultaneous use with the scheme [odds ratio (OR) 1.16; 95% confidence interval (CI) 0.32-4.24], and with subsequent prolonged admission (OR 1.5, 95% CI 0.34-6.7). A somewhat more pronounced dynamics of the epithelization of erosive and ulcerative changes in the mucous membrane of the stomach and duodenum to the 21st and 28th days in the third group of patients was noted. The incidence of adverse events between the groups was comparable: 22.2% in the first group, 24.2% in the second group and 20% in the third group. In the pathomorphological evaluation of biopsy specimens of patients with gastric ulcer at the 6th week after the treatment, significant differences were revealed between the first and third groups in terms of the inflammatory activity in the antrum stomach (2±0.63 vs. 1.4±0.52; p=0,0399). The inclusion of rebamipide in the classical triple scheme of H. pylori ET increases the effectiveness of treatment and does not affect the safety profile. In the post-eradication period, it is advisable to continue the use of rebamipide to potentiate the repair of the gastric mucosa and regress the inflammatory processes.

Furazolidone‐containing triple and quadruple eradication therapy for initial treatment for Helicobacter pylori infection: A multicenter randomized controlled trial in China

The efficacy of Helicobacter pylori (H.pylori) eradication has steadily declined, primarily because of antibiotic resistance. This study aimed to evaluate the efficacy and safety of furazolidone eradication therapies as initial treatments for H.pylori infection. A national, multicenter, open-label, randomized controlled trial was performed at 16 sites across 13 provinces in China to evaluate the efficacy and safety of furazolidone-containing therapies for H.pylori infection. Treatment naïve patients were randomly assigned to: esomeprazole 20mg, bismuth 220mg, amoxicillin 1000mg, and furazolidone 100mg twice daily for 10 and 7days (FAB 10 and FAB 7; the same therapy without bismuth (FA 10 and FA 7). The primary and secondary outcomes were the eradication rate and regimen safety, respectively. Treatment success was assessed by the 13 C urea breath test at least 4weeks after treatment completion. Overall, according to intention-to-treat (ITT) analysis, the eradication rates for FAB 10 and FAB 7 were 86.6% (95% confidence interval [CI], 79.9%-93.2%) and 83.6% (95% CI, 76.3%-90.9%) and for FA 10 and FA 7 were 82.4% (95% CI, 74.9%-89.8%) and 77.6% (95% CI, 69.4%-85.8%), respectively. According to per-protocol analysis, the overall eradication rates for FAB 10 and FAB 7 were 94.7% (95% CI, 90.3%-99.1%) and 90.8% (95% CI, 85.1%-96.5%) and for FA 10 and FA 7 were 90.6% (95% CI, 84.9%-96.3%) and 85.1% (95% CI, 78.2%-92.1%), respectively. The overall prevalence of side effects was 8.1%. Furazolidone-containing therapies, particularly the tested 10-day quadruple therapy, exhibited satisfactory efficacy and safety. This 10-day quadruple therapy represents a promising initial treatment strategy for Chinese patients.

CLINICAL EVALUATION OF TRIPLE AND QUADRUPLE HELICOBACTER PYLORI ERADICATION THERAPY IN PEPTIC ULCER PATIENTS WITH DIFFERENT ABO BLOOD GROUP PHENOTYPES

Objective: This study aimed to examine the pathological changes in gastric mucosa of Helicobacter pylori-infected peptic ulcer patients carrying different ABO phenotypes and to study the response to the 14 days’ standard triple therapy and 10 days’ quadruple therapy in peptic ulcer patients according to their ABO phenotypes.Methods: Interventional prospective randomized-controlled open-label study was performed on newly diagnosed patients with PUD. The H. pylori-positive patients were allocated into two major study groups in which they are subdivided according to ABO blood group phenotypes: Group 1 received standard H. pylori eradication triple therapy and Group 2 received standard H. pylori eradication quadruple regimen. Patients were monitored after 2 months for successful H. pylori eradication.Results: Chronic active gastritis was significantly high in patients carrying blood Group O phenotype (81.25%), while the atrophic gastritis and intestinal metaplasia were significantly high in patients carrying blood Group A phenotype (25.00% and 16.67%), respectively. 14 days’ triple therapy showed significantly lower eradication rate in H. pylori-infected peptic ulcer patients carrying blood Group O phenotype (p<0.01), meanwhile higher response was found among patients with blood Group B. 10 days’ quadruple therapy produced a significant high eradication rate in H. pylori-infected patients carrying blood Group O than those with blood Group A (p<0.01), but still both showed lower response compared to that in patients carrying blood Group B and AB phenotypes. Elderly patients showed significantly less healing efficacy than younger patients (p<0.01), and the least healing rate was noticed in female patients after both regimens.Conclusion: Lower eradication rate in H. pylori-infected was noticed in peptic ulcer patients carrying blood Group O mainly than those with other blood groups and particularly those with duodenal Ulceri. 10 days’ quadruple therapy showed significant higher eradication rate in H. pylori infection and a better ulcer healing efficacy.

The fourth Mexican consensus on Helicobacter pylori.

Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociación Mexicana de Gastroenterología summoned 20 experts to produce "The Fourth Mexican Consensus on Helicobacter pylori". From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosa-associated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed.

Vonoprazan-based triple therapy is non-inferior to susceptibility-guided proton pump inhibitor-based triple therapy for Helicobacter pylori eradication

BackgroundAll Helicobacter pylori-infected patients are recommended for eradication with an appropriate regimen in each geographic area. The choice of the therapy is somewhat dependent on the antimicrobial susceptibility. The rate of clarithromycin resistance has been increasing and is associated with failure; thus, susceptibility testing is recommended before triple therapy with clarithromycin. However, antimicrobial susceptibility testing is not yet clinically available and an alternative newly developed acid inhibitor vonoprazan is used for triple therapy in Japan. The aim of this study was to determine whether vonoprazan-based triple therapy is plausible treatment in H. pylori eradication.MethodsA retrospective observational study of H. pylori eradication was conducted in a single institute. The patients who requested antimicrobial susceptibility testing were treated with susceptibility-guided proton pump inhibitor-based triple therapy in International University of Health and Welfare Hospital from 2013 to 2016. Other patients were treated with empirical treatment with a proton pump inhibitor. From 2015 to 2016, vonoprazan-based triple treatment (vonoprazan, 20 mg; amoxicillin, 750 mg; and clarithromycin, 200 or 400 mg, b.i.d.) was conducted, and its effectiveness was compared with susceptibility-guided proton pump inhibitor-based triple therapy. We also investigated the improvement in eradication rate when antimicrobial susceptibility testing was performed, and compared the outcomes of vonoprazan-based and proton pump inhibitor-based empirical therapy.ResultsA total of 1355 patients who received first-line eradication treatment were enrolled in the present study. The eradication rates of the empirical proton pump inhibitor-based therapy and the vonoprazan-based therapy group in a per-protocol analysis were 86.3% (95% CI 83.8–88.8) and 97.4% (95% CI 95.7–99.1), respectively. In 212 patients who received antimicrobial susceptibility testing, the rate of clarithromycin resistant was 23.5% and the eradication rate in susceptibility-guided treatment was 95.7% (95% CI 92.9–98.4). The difference between susceptibility-guided and vonoprazan-based therapy was − 1.7% (95% CI − 4.9 to 1.5%), and the non-inferiority of vonoprazan-based triple therapy was confirmed.ConclusionsVonoprazan-based triple therapy was effective as susceptibility-guided triple therapy for H. pylori eradication. An empirical triple therapy with vonoprazan is preferable even in area with high rates of clarithromycin-resistance.Trial registration The study was retrospectively registered in University Hospital Medical Information Network (UMIN000032351)

Second-line triple therapy in failures with vonoprazan-based triple therapy for eradication of Helicobacter pylori.

Gastric acid inhibition during treatment is important for the eradication of Helicobacter pylori (H. pylori) infection. A novel potassium-competitive acid blocker, vonoprazan (VPZ), has been demonstrated to achieve high eradication rates; however, the efficacy of second-line treatment in failures of VPZ-based triple therapy has not been well studied. The aim of the current study was to determine the efficacy of VPZ in a first-line regimen for H. pylori eradication, and the efficacy of a second-line regimen using metronidazole (MTZ) in failures with the first-line regimen. Of 580 subjects enrolled in the study, 524 patients completed first-line treatment (275 patients who received VPZ and 249 patients who received LPZ). First-line regimens consisted of a combination of clarithromycin (CAM) 200 or 400 mg twice a day, amoxicillin (AMPC) 750 mg twice a day, and either LPZ 30 mg or VPZ 20 mg twice a day, administered orally for 7 days. CAM and VPZ/LPZ were replaced with metronidazole (MTZ) 250 mg and rabeprazole 10 mg in the second-line regimens. The eradication of H. pylori was assessed by the H. pylori stool antigen test. The overall first-line eradication rate with VPZ was significantly higher than that with LPZ [91.0% (250/275) vs. 84.7% (211/249), respectively, P=0.030]. The dose of CAM (400 vs. 800 mg) did not affect the eradication rate in either the VPZ or LPZ regimens. The overall eradication rates of the second-line regimens with MTZ did not differ significantly between the VPZ-failure and LPZ-failure groups [87.0% (20/23) vs. 87.9% (29/33), respectively, P=0.700]. Therefore, VPZ was significantly more effective than LPZ for first-line treatment. In patients with failure of first-line eradication therapy, successful results of second-line eradication therapy did not differ between the VPZ- and LPZ-failure groups. In conclusion, VPZ-based triple therapy should be recommended for eradication of H. pylori.

Tu1297 - High Dose Cam is Better on Vonoprazan (P-Cab) Plus Amx with Cam Based H.Pylori Eradication Triple Therapy Regimen Even If Cam Resistance; Multicenter Prospective Case Study

Tu1297 - High Dose Cam is Better on Vonoprazan (P-Cab) Plus Amx with Cam Based H.Pylori Eradication Triple Therapy Regimen Even If Cam Resistance; Multicenter Prospective Case Study

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

Treatment of helicobacter pylori contamination in patients with type 2 diabetes mellitus with gastroduodenal disorders

Background: The treatment of Helicobacter pylori (HP) infection in patients with diabetes mellitus with chronic gastroduodenal disorders is a substantial problem because of its high incidence.
 Aims: To compare between the effectiveness of triple and optimised consecutive regimens in anti-HP treatment in patients with type 2 diabetes mellitus with gastroduodenal disorders.
 Materials and methods: The study included 54 patients with diabetes mellitus and 64 healthy individuals (the control group) aged 3060 years. Gastroduodenal pathology was confirmed by gastroduodenoscopy; HР contamination was confirming using Marshalls urease method or by finding bacterial antigen in excrements. We studied the dynamics of clinical manifestations using the GSRS scale and showed remission via endoscopy and the effectiveness of HР eradication. We also analysed the effects of anti-HР therapy regimens on the presence of small intestinal bacterial overgrowth syndrome (SIBOS) in patients with diabetes mellitus. SIBOS was diagnosed via the respiratory hydrogen method.
 Results: The use of an optimised consecutive regimen resulted in HР eradication in 85.7% of patients with diabetes mellitus compared with a 65.3% eradication in patients on the triple therapy. Moreover, clinical improvement and endoscopy-confirmed remission were more frequently observed in patients on the optimised consecutive regimen. A statistically significant decrease in the number of patients with SIBOS was found only in patients who underwent the optimised consecutive therapy regimen.
 Conclusions: This study showed that the optimised consecutive therapy regimen was more effective than the triple therapy in HP eradication.

Berberine Combined with Triple Therapy versus Triple Therapy for Helicobacter pylori Eradication: A Meta-Analysis of Randomized Controlled Trials.

Objective To assess the effects and safety of berberine combined with triple therapy on Helicobacter pylori (H. pylori) eradication in adults. Methods PubMed, MEDLINE, EMBASE, Cochrane Library, and Chinese databases including China National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Technology Journal Full-text Database (VIP), and China biomedical literature database (CBM) were searched to obtain the eligible studies published up to October 10, 2017. The primary outcome was eradication rate of H. pylori. The secondary outcome was incidence of adverse effects. Data analysis was conducted by RevMan5.2 and Stata V.9.0 software. Trial sequential analysis (TSA) was performed to assess the risk of random error and the validity of conclusion with TSA program version 0.9 beta. Results The meta-analysis results indicated berberine combined with triple therapy could improve the eradication rates of H. pylori (urea breath test subgroup: RR=1.18, 95%CI=(1.12,1.24), P < 0.00001, biopsy subgroup: RR=1.23, 95%CI=(1.13,1.34), P < 0.00001) and reduce the total occurrence of adverse effects (OR=0.59, 95%CI(0.46, 0.75), P < 0.0001) when compared with only using triple therapy. Besides, the incidence of nausea (OR=0.59, 95%CI(0.41, 0.86), P < 0.05) and diarrhea (OR=0.41, 95%CI(0.24, 0.71) was remarkably lower in experimental group while that of abdominal distention (OR=0.64, 95%CI(0.40,1.04), P > 0.05) and vomiting (OR=0.65, 95%CI(0.37, 1.15), P > 0.05) had no significant change. TSA of H. pylori eradication rates and adverse effects incidence illustrated that the cumulative value of Z-curve went across the conventional boundary value, trial sequential monitoring boundary for benefit, and required information size, suggesting the results were stable. Conclusion Evidence from meta-analysis suggested that berberine combined with triple therapy can be an option for increasing H. pylori eradication rates and reducing overall therapy-related adverse effects incidence, particularly nausea and diarrhea, whereas more randomized controlled trials designed according to CONSORT statement are demanded to support the efficacy in further studies.

Levofloxacin-based sequential therapy versus classic triple therapy in Helicobacter pylori eradication: A randomized clinical trial

Introduction: During the past two decades, eradication rates with triple therapy for Helicobacter (H.) pylori eradication have decreased. The decline of effectiveness of the triple therapy have led to investigations to achieve more effective and safe therapeutic strategies. Sequential, concomitant and hybrid therapeutic regimens are new therapies that have been introduced over the past two decades. The purpose of this study was to compare levofloxacin-based sequential therapy versus classic triple therapy in H. pylori eradication in a randomized clinical trial.&#x0D; Methods: All eligible cases were divided into two groups using a randomized block method. The first group (classic group) was treated with triple therapy; patients received omeprazole, amoxicillin and clarithromycin for 14 days. The second group received the levofloxacin-based sequential (lev-seq) regimen; the patients were treated with omeprazole and amoxicillin for the first 7 days and then with omeprazole, levofloxacin and metronidazole for the latter 7 days. In this clinical trial, 200 patients with H. pylori infection were enrolled. Ultimately, 192 patients completed the study. Of these, 95 patients (46 males and 49 females) were treated with triple therapy (classic group) and 97 patients (46 males and 51 females) were treated with the lev-seq regimen. The average age in the classic group and lev-seq groups were 41.4±12.4 years and 40.2±11.8 years, respectively.&#x0D; Results: The levofloxacin based sequential regimen was more effective than triple therapy regimen. It is recommended that the lev-seq regimen be used as the first-line therapy, especially in areas with high levels of resistance to clarithromycin (over 20%).&#x0D; Conclusion: Further studies with large numbers of samples are required to be conducted in different parts of the country for further evaluation of efficacy of this regimen.&#x0D; Peer Review Details&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Peer review method: Single-Blind (Peer-reviewers: 02) Peer-review policy &#x0D; Plagiarism software screening?: Yes&#x0D; Date of Original Submission: 05 November 2017&#x0D; Date accepted: 25 November 2017&#x0D; Peer reviewers approved by: Dr. Lili Hami &#x0D; Editor who approved publication: Dr. Phuc Van Pham&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Comparative study of sequential therapy versus standard triple therapy versus quinolone-based triple therapy for eradication of Helicobacter pylori infection

Comparative study of sequential therapy versus standard triple therapy versus quinolone-based triple therapy for eradication of Helicobacter pylori infection

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.

Vonoprazan-Based Dual Therapy With Amoxicillin Is as Effective as the Triple Therapy for Eradication of H. pylori

Introduction: Vonoprazan is the first clinically available potassium competitive acid blocker (P-CAB). This class of agents provides faster and more potent acid inhibition than PPIs. Most strains of H. pylori are sensitive to amoxicillin. We hypothesized that dual therapy with a P-CAB and amoxicillin would provide sufficient eradication rates for H. pylori infection. To evaluate this, we compared the eradication rate with dual vonoprazan/amoxicillin therapy with those with the standard triple vonoprazan/amoxicillin/clarithromycin therapy. Methods: A total of 61 patients infected with H. pylori were randomly assigned to the dual therapy or triple therapy. Thirty patients assigned to dual therapy were treated with vonoprazan 20 mg bid + amoxicillin 500 mg tid for 1 week, and thrity-one assigned to triple therapy with vonoprazan 20 mg bid, amoxicillin 750 mg bid and clarithromycin 200 mg for 1 week. Successful eradication was diagnosed using the 13C-urea breath test at 1 month after eradication therapy. Results: The eradication rate with dual vonoprazan/amoxicillin therapy was 93.3% (28/30), while that with the triple therapy was 90.3% (28/31). There were no differences in the incidence of adverse events related to the study regimens. Conclusion: Vonoprazan-based dual therapy (vonoprazan 20 mg bid + amoxicillin 500 mg tid for 1 week) provides acceptable eradication rates of H. pylori infection without the need for second antimicrobial agents, such as clarithromycin.

Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea.

The efficacy of the standard triple therapy for Helicobacter pylori eradication has decreased to an unacceptable level. We aimed to compare the efficacy of sequential and concomitant therapies as for the first-line treatments for H. pylori eradication and analyzed the effect of clarithromycin resistance on the eradication rates. Four hundred and seventy-eight patients with H. pylori infection were randomly assigned to either concomitant therapy (amoxicillin 1000mg with clarithromycin 500mg, metronidazole 500mg, and pantoprazole 40mg twice daily for 10days) or sequential therapy (amoxicillin 1000mg with pantoprazole 40mg twice daily for 5days, followed by clarithromycin 500mg with metronidazole 500mg and pantoprazole 40mg twice daily for 5days). The success of the eradication was evaluated 4-5weeks after treatment completion. To evaluate the efficacy of the two regimens according to clarithromycin sensitivity, dual-priming oligonucleotide-based multiplex-polymerase chain reaction was also performed in the final third of the enrolled study populations. The eradication rates with concomitant or sequential therapy were 81.9% and 76.6% (P=.153) in intention-to-treat analysis, and 93.4% and 84.8% (P=.004) in per-protocol analysis, respectively. Among the 156 patients for whom dual-priming oligonucleotide-based multiplex-polymerase chain reaction was performed, 17.9% were clarithromycin resistant, and the efficacy of concomitant therapy was better than sequential therapy in the clarithromycin-resistant strains (100% vs 58.3%, P=.010). Concomitant therapy was superior to sequential therapy as the first-line treatment for H. pylori eradication, especially in clarithromycin-resistant strains in Korea.

Efficacy of three-in-one capsule bismuth quadruple therapy for Helicobacter pylori eradication in clinical practice in a multinational patient population.

Bismuth quadruple therapy (BQT) has been proven superior to standard triple therapy for Helicobacter pylori eradication in randomized clinical trials; however, little is known about the efficacy of BQT in daily routine practice. In a single-center cohort study, we analyzed consecutive H.pylori-positive patients in whom three-in-one capsule BQT (Pylera® + omeprazole) has been prescribed. All patients were instructed in a standardized fashion, and a prospective follow-up was planned. PCR on gastric biospies for clarithromycin and levofloxacin resistance was performed before treatment in a subgroup of patients. Treatment outcome was assessed by 13C urea breath test or by histology not earlier than 4weeks after end of treatment. Three-in-one capsule BQT has been prescribed in 322 patients. Approximately 70.2% of patients had a migrational background. PCR results were available in 163 patients and identified resistance to clarithromycin and levofloxacin in 29 (17.8%) and 20 (12.3%) of cases, respectively. BQT was prescribed as first-line, second-line, and salvage treatments in 74%, 17%, and 9% of cases, respectively. Five patients discontinued treatment due to side effects (1.8%). By modified intention-to-treat and per-protocol analyzes, the overall H.pylori eradication rates were 95.0% (95% CI 94.92%-95.08%) and 96.7% (95% CI 94.6%-98.8%), respectively. The low number of treatment failures (n=9) did not allow to identify risk factors for failure. Three-in-one capsule bismuth quadruple therapy is effective and safe for treatment of H.pylori infection in routine practice, irrespective of the patient's migrational background or the number of previous treatment failures.

Luminal Clinical

<b>Luminal Clinical</b>

Evaluation of H. pylori - Eradication Triple Therapy in Iraqi Peptic Ulcer Patients according to ABO Phenotypes: a New Study

Infection with H. pylori is an up growing public health problem that affects approximately 50% of people in industrialized nations, and up to 80% in developing countries. Helicobacter pylori (H. pylori) infection had been identified as the main causes of peptic ulcer disease (PUD). Blood group A phenotype was associated with gastric ulcer (GU) and gastric carcinoma, while blood group O phenotype found to be associated with duodenal ulcer DU predominantly; however, no explanation for this association was received. This study was conducted to, first, determine the relationship between ABO blood groups and H. pylori infection in peptic ulcer patients, and second, to study the response to the two weeks H. pylori eradication triple therapy in peptic ulcer patients carrying different blood groups. A total of 84 patients who presented with symptoms of PUD and showed positive endoscopic examination of PUD and evidence of H. pylori infection by histology and stool antigen test, were divided into four groups according to ABO blood group phenotype. All H. pylori infected patients received standard H. pylori eradication triple therapy for 14 days duration. Patients were followed up by re- endoscopic examination after 2 months of treatment course. The percentage of H. pylori infection in patients with peptic ulcer disease carrying blood group O was higher than other blood group phenotype. In H. pylori-infected peptic ulcer patients, higher incidence of gastric ulcer (GU) was noticed among blood group A carriers, while higher incidence of duodenal ulcer (DU) was found among blood group O carriers when compare with other blood group phenotypes. Fourteen days triple therapy showed lower eradication rate in H. pylori infected blood group O peptic ulcer patients, while a higher response to the standard H. pylori eradication triple therapy was found among patients with blood group B phenotype.