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Comparative Study
. 2019 Dec 14;25(46):6743-6751.
doi: 10.3748/wjg.v25.i46.6743.

Tailored eradication vs empirical bismuth-containing quadruple therapy for first-line Helicobacter pylori eradication: A comparative, open trial

Youn I Choi  1 , Jun Won Chung  2 , Dong Kyun Park  1 , Kyoung Oh Kim  1 , Kwang An Kwon  1 , Yoon Jae Kim  1 , Ja Young Seo  3
Affiliations
Comparative Study

Tailored eradication vs empirical bismuth-containing quadruple therapy for first-line Helicobacter pylori eradication: A comparative, open trial

Youn I Choi et al. World J Gastroenterol. .

Abstract

Background: Few studies have compared the efficacy and safety profile of a tailored eradication (TR) strategy based on the presence of a 23S ribosomal RNA point mutation with those of empirical bismuth-based quadruple therapy (EBQT) for first-line eradication of Helicobacter pylori (H. pylori) in Korean patients.

Aim: To compare the efficacy and safety of a TR strategy and those of EBQT regimen as first-line eradication therapy for H. pylori.

Methods: This is an open-label, comparative study in which we prospectively enrolled patients over 18 years of age with H. pylori infection and retrospectively reviewed their data. H. pylori-positive patients diagnosed by rapid urease test, Giemsa staining, or dual priming oligonucleotide polymerase chain reaction (DPO-PCR) were enrolled from May 2016 to September 2018 at Gil Medical Center. Patients with H. pylori infection received either a TR regimen or the EBQT regimen. In the tailored therapy group that underwent DPO-PCR testing, patients with A2142G and/or A2143G point mutations were treated with a bismuth-containing quadruple regimen. The eradication rate, patient-reported side effect rate, and H. pylori eradication success rate were evaluated and compared between the groups.

Results: A total of 150 patients were assigned to the TR (n = 50) or EBQT group (n = 100). The first-line eradication rate of H. pylori did not differ between the groups (96.0% vs 95.7%, P = 0.9). The rate of eradication-related side effects for TR was 12.0%, which differed significantly from that of EBQT (43.0%) for first-line treatment (P < 0.001).

Conclusion: DPO-PCR-based TR for H. pylori eradication may be equally efficacious, with less treatment-related complications, compared to EBQT in Korea, where clarithromycin resistance is high.

Keywords: Helicobacter pylori; Empirical; Eradication; Quadruple; Tailored.

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Conflict of interest statement

Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Figure 1
Figure 1
Flow chart. DPO-PCR: Dual priming oligonucleotide polymerase chain reaction; ITT: Intention-to-treat analysis; PP: Per-protocol analysis.
See this image and copyright information in PMC

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