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Comparison of 10 and 14 days sequential therapy for the eradication of helicobacter pylori

Year 2017, Volume: 16 Issue: 3, 91 - 96, 20.11.2017
https://doi.org/10.17941/agd.351642

Abstract

Background and Aims: The eradication rate of Helicobacter pylori using standard triple therapy (amoxicillin+clarithromycin+proton pump inhibitor) as the first-line therapy has fallen below 50%. This prospective, randomized study was conducted to compare the 5+5 (10)-day and 7+7 (14)-day sequential treatment results in patients with peptic ulcer (gastric ulcer and/or duodenal ulcer) who were identified as histologically positive for Helicobacter pylori infection by gastroscopy. Materials and Methods: This study included 66 patients who had peptic ulcer diagnosed through gastroscopy, had at least two histopatholgically positive results, underwent urea breath test, had positive stool test for Helicobacter pylori antigen, and did not receive eradication therapy before. These patients were randomly divided into two groups and enrolled into the study between March 2014 and August 2015. Group 1 patients (n=33) were administered amoxicillin 1 g+esomeprazole 40 mg 2x1 for the first 5 days, followed by clarithromycin 500 mg+metronidazole 500 mg+esomeprazole 40 mg 2x1 for the next 5 days. Group 2 patients (n=33) were administered amoxicillin 1 g+esomeprazole 40 mg 2x1 for the first 7 days, followed by clarithromycin 500 mg+metronidazole 500 mg+esomeprazole 40 mg 2x1 for the next 7 days. Esomeprazole 40 mg (1x1) treatment was completed during 12 weeks in both groups. After a drug-free period of 15 days, the eradication rate was analyzed by urea breath test and Helicobacter pylori antigen stool test. Results: Ten patients in Group 1 (30.3%) were females, with a meanage of 38.0±13.1 years. Twelve patients in Group 2 (34.4%) were females, with a mean age of 39.0±15.6 years. After treatment, the urea breath test and Helicobacter pylori antigen stool test revealed an eradication rate of 70% in Group 1 and 72.7% in Group 2, with an overall eradication rate of 71.2% in all patients. No significant difference was observed between the two groups. Conclusion: At the end of the consecutive 5+5-day and 7+7-day treatment, an eradication rate of about 70% was achieved in all patients. Although not ideal, this eradication rate implies that the 5+5 (10)-day consecutive treatment could be used an alternative first-line therapy.


References

  • 1. Cave DR. Transmission and epidemiology of Helicobacter pylori. Am J Med 1996;100:12-7. 2. Açık Y, Gülbayrak C, Dönder E, Yalnız M. Fırat Tıp merkezine dispeptik yakınmalarla başvuran hastalarda Helicobacter pylori sıklığı ve etkileyen faktörler. OMÜ Tıp Fak Derg 2003;20:82-8. 3. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-3. 4. Megraud F. Transmission of Helicobacter pylori: Fecal-oral versus oral-oral route. Aliment Pharmacol Ther 1995;9(Suppl 2):85-6. 5. Ermis F, Akyuz F, Uyanikoglu A, et al. Second-line levofloxacin-based triple therapy’s efficiency for Helicobacter pylori eradication in patients with peptic ulcer. South Med J 2011;104:579-83. 6. Uyanıkoğlu A, Coşkun M, Binici DN. Helikobakter pilori eradikasyonunda klasik 3’lü tedavi Doğu Anadolu Bölgesinde halen etkilidir. Akademik Gastroenteroloji Dergisi 2012;11:24-8. 7. Koneman EW, Allen SD, Janda WM, et al. Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott-Raven Publishers, 2006;403-8. 8. Muhsen KH, Athamna A, Athamna M, et al. Prevalence and risk factors of Helicobacter pylori infection among healthy 3- to 5-year old Israeli Arab children. Epidemiol Infect 2006;134:990-6. 9. Bulut M, Armağan E, Kıyıcı M, et al. Acil servise epigastrik ağrı yakınmasıyla başvuran hastalarda Helicobacter pylori sıklığı ve tanıda kalitatif serum IgG testinin yeri. Uludağ Üni Tıp Fak Derg 2004;30:7-10. 10. Ataseven H, Demir A, Keçeci M. Peptik ülsere bağlı üst gastrointestinal kanamalı olgularda Helicobacter pylori eradikasyonunun fekal antijen testi ile tespiti. FÜ Tıp Fak Derg 2004;18:199-204. 11. Coşkun M, Dobrucalı A. Non-steroid anti-inflamatuar ilaçlar ve Helicobacter pylori [Non-steroid anti-inflammatory drugs and Helicobacter pylori]. Turkiye Klinikleri J Int Med Sci 2005;1:26-8. 12. Bazzoli F, Bianchi-Porro G, Bianchi MG, et al. Treatment of Helicobacter pylori infection. Indications and regimens: an update. Dig Liver Dis 2002;34:70-83. 13. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection Report. Gut 2007;56:772-81. 14. Vaira D, Zullo A, Vakil N, et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a randomized trial. Ann Intern Med 2007;146:556-63. 15. Essa AS, Kramer JR, Graham DY, Treiber G. Metaanalysis: fourdrug, three-antibiotic, non-bismuth-containing “concomitant therapy” versus triple therapy for Helicobacter pylori eradication. Helicobacter 2009;14:109-18. 16. Pilotto A, Franceschi M, Rassu M, et al. Invitro activity of rifabutin against strains of Helicobacter pylori resistant to metronidazole and clarithromycin. Am J Gastroenterol 2000;95:833-4. 17. Jiang ZD, DuPont HL. Rifaximin: in vitroand in vivo antibacterial activity: a review. Chemotherapy 2005;51(Suppl 1):67-72. 18. Uyanıkoğlu A, Davutoğlu C, Toğan M, Ranitidin bizmut sitrat ve llaritromisinli ikili kombinasyonla alternatif Helikobakter pylori tedavisi. İst Tıp Fak Derg 2008;71:61-4. 19. Lind T, Mégraud F, Unge P, et al. The MACH2 study: role of omeprazole in eradication of Helicobacter pylori with 1-week triple therapies. Gastroenterology 1999;116:248-53. 20. Alkim H, Iscan M, Oz F. Effectiveness of ranitidine bismuth citrate and proton pump inhibitor based triple therapies of Helicobacter pylori in Turkey. Libyan J Med 2011;6:8412. 21. Rathbone M, Rathbone B. Helicobacter pylori and gastric cancer. Recent Results Cancer Res 2011;185:83-97. 22. Kuipers EJ. When is endoscopic follow-up appropriate after Helicobacter pylori eradication therapy. Gastroenreol Clin North Am 2015;44:597-608. 23. Uyanıkoğlu A, Danalıoğlu A, Akyüz F, et al. Etiological factors of duodenal and gastric ulcers. Turk J Gastroenterol 2012;23:99-103. 24. Anda RF, Williamson DF, Escobedo LG, Remington PL. Smoking and the risk of peptic ulcer disease among women in the United States. Arch Intern Med 1990;150:1437-41. 25. Rosenstock SJ, Jorgensen T, Bonnevie O, Andersen LP. Does Helicobacter pylori infection explain all socio-economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults. Scand J Gastroenterol 2004;39:823-9. 26. Allahverdiyev AM, Bagirova M, Caliskan R, et al. Isolation and diagnosis of Helicobacter pylori by a new method: microcapillary culture. World J Gastroenterol 2015;21:2622-8. 27. Yazbek PB, Trindade AB, Chin CM, Dos SantosJL. Challenges to the treatment and new perspectives for the eradication of Helicobacter pylori. Dig Dis Sci 2015;60:2901-12. 28. Demir M, Ataseven H. The effects of sequential treatment as a first-line therapy for Helicobacter pylori eradication. Turk J Med Sci 2011;41:427-33. 29. Sezikli M, Cetinkaya ZA, Guzelbulut F, et al. Supplementing vitamins C and E to standard triple therapy for the eradication of Helicobacter pylori. J Clin Pharm Ther 2012;37:282-5. 30. O’Connor A, Molina-Infante J, Gisbert JP, O’Morain C. Treatment of Helicobacter pylori infection 2013. Helicobacter 2013;18:58-65. 31. Sarıkaya M, Taşer N, Ergül B, et al. The effect of Helicobacter pylori eradication with sequential therapy in patients with peptic ulcer or functional dyspepsia. Endoscopy Gastrointestinal 2013;21:61-3. 32. Oh HS, Lee DH, Seo JY, et al. Ten-day sequential therapy is more effective than proton-pump inhibitor-based therapy in Korea: a prospective randomized study. J Gastroenterol Hepatol 2012;27:504-9. 33. Sezgin O, et al. A pilot study evaluating sequential administration of a PPI-Amokxicillin followed by a PPI-metronidazole-tetracycline in Turkey. Helicobacter 2007:12:629-32.

Helicobacter pylori eradikasyonunda ardışık 5+5 (10) günlük ve ardışık 7+7 (14) günlük tedavilerin karşılaştırılması

Year 2017, Volume: 16 Issue: 3, 91 - 96, 20.11.2017
https://doi.org/10.17941/agd.351642

Abstract

Giriş ve Amaç: 1. basamak Helicobacter pylori tedavisinde klasik 3’lü tedavi amoksisilin+klaritromisin+proton pompa inhibitörü) ile eradikasyon oranları %50’lerin altına düşmüştür. Bu randomize, prospektif çalışmada gastroskopisinde peptik ülser (gastrik ülser ve/veya duodenal ülser) saptanan, histopatolojik olarak Helicobacter pylori pozitif olan hastalarda 5+5 (10) günlük ve 7+7 (14) günlük ardışık tedavi sonuçlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Mart 2014-Ağustos 2015 tarihleri arasında gastroskopide peptik ülser saptanan, histopatoloji, üre-nefes testi veya gaitada Helicobacter pylori antijeni sonuçlarından en az ikisinde pozitiflik tespit edilen ve daha önce eradikasyon tedavisi almamış 66 hasta ardışık olarak 2 gruba randomize edilerek çalışmaya alındı. Grup 1 hastalara (n: 33) 5 gün (amoksisilin 1 gr+esomeprazol 40 mg 2x1) ardından 5 gün (klaritromisin 500 mg+- metronidazol 500 mg+esomeprazol 40 mg 2x1) verildi. Grup 2 hastalara (n: 33) 7 gün (amoksisilin 1 gr+esomeprazol 40 mg 2x1) ardından 7 gün (klaritromisin 500 mg+metronidazol 500 mg+esomeprazol 40 mg 2x1) verildi. Her iki grupta esomeprazol 40 mg (1x1) 12 haftaya tamamlandı. 15 gün ilaçsız dönem sonrası üre-nefes testi ve gaitada Helicobacter pylori antijen testi ile eradikasyon kontrolü yapıldı. Bulgular: Grup 1 hastalarının 10’u (%30.3) kadın, yaş ortalaması 38±13.1 yaş, grup 2 hastalarının 12’si kadın (%34.4), yaş ortalaması 39±15.6 yaş idi. Tedavi sonrası üre-nefes testi ve gaitada Helicobacter pylori antijen testi ile yapılan değerlendirmede grup 1’de eradikasyon oranı %70, grup 2’de %72.7, toplamda %71.2 saptandı. İki grup arasında istatistiksel anlamlı farklılık yoktu. Sonuç: Ardışık 5+5 (10) günlük ve 7+7 (14) günlük tedavi sonucunda benzer şekilde yüzde yetmiş civarında eradikasyon sağlanmıştır. Çok ideal olmamakla birlikte bu eradikasyon oranı 5+5 (10) günlük ardışık tedavinin 1. basamak için alternatif olabileceğini göstermiştir.


References

  • 1. Cave DR. Transmission and epidemiology of Helicobacter pylori. Am J Med 1996;100:12-7. 2. Açık Y, Gülbayrak C, Dönder E, Yalnız M. Fırat Tıp merkezine dispeptik yakınmalarla başvuran hastalarda Helicobacter pylori sıklığı ve etkileyen faktörler. OMÜ Tıp Fak Derg 2003;20:82-8. 3. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-3. 4. Megraud F. Transmission of Helicobacter pylori: Fecal-oral versus oral-oral route. Aliment Pharmacol Ther 1995;9(Suppl 2):85-6. 5. Ermis F, Akyuz F, Uyanikoglu A, et al. Second-line levofloxacin-based triple therapy’s efficiency for Helicobacter pylori eradication in patients with peptic ulcer. South Med J 2011;104:579-83. 6. Uyanıkoğlu A, Coşkun M, Binici DN. Helikobakter pilori eradikasyonunda klasik 3’lü tedavi Doğu Anadolu Bölgesinde halen etkilidir. Akademik Gastroenteroloji Dergisi 2012;11:24-8. 7. Koneman EW, Allen SD, Janda WM, et al. Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott-Raven Publishers, 2006;403-8. 8. Muhsen KH, Athamna A, Athamna M, et al. Prevalence and risk factors of Helicobacter pylori infection among healthy 3- to 5-year old Israeli Arab children. Epidemiol Infect 2006;134:990-6. 9. Bulut M, Armağan E, Kıyıcı M, et al. Acil servise epigastrik ağrı yakınmasıyla başvuran hastalarda Helicobacter pylori sıklığı ve tanıda kalitatif serum IgG testinin yeri. Uludağ Üni Tıp Fak Derg 2004;30:7-10. 10. Ataseven H, Demir A, Keçeci M. Peptik ülsere bağlı üst gastrointestinal kanamalı olgularda Helicobacter pylori eradikasyonunun fekal antijen testi ile tespiti. FÜ Tıp Fak Derg 2004;18:199-204. 11. Coşkun M, Dobrucalı A. Non-steroid anti-inflamatuar ilaçlar ve Helicobacter pylori [Non-steroid anti-inflammatory drugs and Helicobacter pylori]. Turkiye Klinikleri J Int Med Sci 2005;1:26-8. 12. Bazzoli F, Bianchi-Porro G, Bianchi MG, et al. Treatment of Helicobacter pylori infection. Indications and regimens: an update. Dig Liver Dis 2002;34:70-83. 13. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection Report. Gut 2007;56:772-81. 14. Vaira D, Zullo A, Vakil N, et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a randomized trial. Ann Intern Med 2007;146:556-63. 15. Essa AS, Kramer JR, Graham DY, Treiber G. Metaanalysis: fourdrug, three-antibiotic, non-bismuth-containing “concomitant therapy” versus triple therapy for Helicobacter pylori eradication. Helicobacter 2009;14:109-18. 16. Pilotto A, Franceschi M, Rassu M, et al. Invitro activity of rifabutin against strains of Helicobacter pylori resistant to metronidazole and clarithromycin. Am J Gastroenterol 2000;95:833-4. 17. Jiang ZD, DuPont HL. Rifaximin: in vitroand in vivo antibacterial activity: a review. Chemotherapy 2005;51(Suppl 1):67-72. 18. Uyanıkoğlu A, Davutoğlu C, Toğan M, Ranitidin bizmut sitrat ve llaritromisinli ikili kombinasyonla alternatif Helikobakter pylori tedavisi. İst Tıp Fak Derg 2008;71:61-4. 19. Lind T, Mégraud F, Unge P, et al. The MACH2 study: role of omeprazole in eradication of Helicobacter pylori with 1-week triple therapies. Gastroenterology 1999;116:248-53. 20. Alkim H, Iscan M, Oz F. Effectiveness of ranitidine bismuth citrate and proton pump inhibitor based triple therapies of Helicobacter pylori in Turkey. Libyan J Med 2011;6:8412. 21. Rathbone M, Rathbone B. Helicobacter pylori and gastric cancer. Recent Results Cancer Res 2011;185:83-97. 22. Kuipers EJ. When is endoscopic follow-up appropriate after Helicobacter pylori eradication therapy. Gastroenreol Clin North Am 2015;44:597-608. 23. Uyanıkoğlu A, Danalıoğlu A, Akyüz F, et al. Etiological factors of duodenal and gastric ulcers. Turk J Gastroenterol 2012;23:99-103. 24. Anda RF, Williamson DF, Escobedo LG, Remington PL. Smoking and the risk of peptic ulcer disease among women in the United States. Arch Intern Med 1990;150:1437-41. 25. Rosenstock SJ, Jorgensen T, Bonnevie O, Andersen LP. Does Helicobacter pylori infection explain all socio-economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults. Scand J Gastroenterol 2004;39:823-9. 26. Allahverdiyev AM, Bagirova M, Caliskan R, et al. Isolation and diagnosis of Helicobacter pylori by a new method: microcapillary culture. World J Gastroenterol 2015;21:2622-8. 27. Yazbek PB, Trindade AB, Chin CM, Dos SantosJL. Challenges to the treatment and new perspectives for the eradication of Helicobacter pylori. Dig Dis Sci 2015;60:2901-12. 28. Demir M, Ataseven H. The effects of sequential treatment as a first-line therapy for Helicobacter pylori eradication. Turk J Med Sci 2011;41:427-33. 29. Sezikli M, Cetinkaya ZA, Guzelbulut F, et al. Supplementing vitamins C and E to standard triple therapy for the eradication of Helicobacter pylori. J Clin Pharm Ther 2012;37:282-5. 30. O’Connor A, Molina-Infante J, Gisbert JP, O’Morain C. Treatment of Helicobacter pylori infection 2013. Helicobacter 2013;18:58-65. 31. Sarıkaya M, Taşer N, Ergül B, et al. The effect of Helicobacter pylori eradication with sequential therapy in patients with peptic ulcer or functional dyspepsia. Endoscopy Gastrointestinal 2013;21:61-3. 32. Oh HS, Lee DH, Seo JY, et al. Ten-day sequential therapy is more effective than proton-pump inhibitor-based therapy in Korea: a prospective randomized study. J Gastroenterol Hepatol 2012;27:504-9. 33. Sezgin O, et al. A pilot study evaluating sequential administration of a PPI-Amokxicillin followed by a PPI-metronidazole-tetracycline in Turkey. Helicobacter 2007:12:629-32.
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Details

Journal Section Articles
Authors

Çiğdem Cindoğlu

Ahmet Uyanıkoğlu

Umut Sert This is me

Necati Yenice This is me

Publication Date November 20, 2017
Published in Issue Year 2017 Volume: 16 Issue: 3

Cite

APA Cindoğlu, Ç., Uyanıkoğlu, A., Sert, U., Yenice, N. (2017). Helicobacter pylori eradikasyonunda ardışık 5+5 (10) günlük ve ardışık 7+7 (14) günlük tedavilerin karşılaştırılması. Akademik Gastroenteroloji Dergisi, 16(3), 91-96. https://doi.org/10.17941/agd.351642

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