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Comparative Study
. 2012 Sep 7;18(33):4542-8.
doi: 10.3748/wjg.v18.i33.4542.

Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection

Giuliana Sereni  1 , Francesco Azzolini, Lorenzo Camellini, Debora Formisano, Francesco Decembrino, Veronica Iori, Cristiana Tioli, Maurizio Cavina, Francesco Di Mario, Giuliano Bedogni, Romano Sassatelli
Affiliations
Comparative Study

Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection

Giuliana Sereni et al. World J Gastroenterol. .

Abstract

Aim: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication.

Methods: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test (UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d.

Results: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and third-line therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate.

Conclusion: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and second-line treatment can still be triple therapy with amoxicillin and tinidazole.

Keywords: Eradication rate; Eradication treatment; First-line therapy; Helicobacter pylori; Rescue therapy; Second-line therapy; Triple therapy.

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Figures

Figure 1
Figure 1
Flow chart of the study. UBT: Urea breath test; H. pylori: Helicobacter pylori.
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