Effect of ornidazole and clarithromycin resistance on eradication of Helicobacter pylori in peptic ulcer disease

BACKGROUND: Clarithromycin and nitroimidazoles such as metronidazole and ornidazole are among the most frequently used antibiotics for curing Helicobacter pylori infection. However, controversial data exist on whether their in vitro resistance has a negative impact on treatment outcome. METHODS: Patients with H. pylori positive active peptic ulcer disease were randomly assigned to receive lansoprazole 30 mg o.d., amoxycillin 1 g b.d. and ornidazole 500 mg b.d. (LAO) or lansoprazole 30 mg o.d., amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. (LAC) for 2 weeks. Pre-treatment resistance to ornidazole and clarithromycin was assessed by Epsilometer (E-) test. Four weeks after completion of treatment, patients underwent a 13C urea breath test to assess H. pylori status. RESULTS: Data from 80 patients with active peptic ulcer disease and positive H. pylori status were analysed. The prevalence of primary drug resistance was 25% for metronidazole and 7.5% for clarithromycin. In patients treated with LAO, effective treatment was achieved in 87% of metronidazole-susceptible, but only 30% of metronidazole-resistant strains (P < 0.01). In the LAC group, therapy was successful in 81% of clarithromycin-susceptible strains, whereas treatment failed in all patients with primary clarithromycin resistance (n = 3). CONCLUSION: Resistance against nitroimidazoles significantly affects treatment outcome in H. pylori eradication therapy.     

Impact of intravenous omeprazole on Helicobacter pylori eradication by triple therapy in patients with peptic ulcer bleeding

AIM: To test the impact of intravenous omeprazole on Helicobacter pylori eradication for bleeding peptic ulcers. METHODS: A total of 175 H. pylori-infected patients with bleeding peptic ulcers were randomized into either an omeprazole group or a ranitidine group, receiving intravenous omeprazole or ranitidine for 3 days after endoscopy. Afterwards, 1-week triple therapy was used to eradicate H. pylori for both groups. Six weeks later, either a 13C-urea breath test or follow-up endoscopy was performed to assess the success of H. pylori eradication. RESULTS: The rebleeding rate was lower in the omeprazole group vs. the ranitidine group (6% vs. 17%, P < 0.05). The H. pylori eradication rate was higher in the omeprazole group (intention-to-treat analysis: 83% vs. 66%, P < 0.05; per protocol analysis: 93% vs. 80%, P < 0.05). For patients with duodenal ulcers, the per protocol H. pylori eradication rate of the omeprazole group was higher than that of the ranitidine group (93% vs. 73%, P < 0.05). CONCLUSIONS: Intravenous omeprazole can decrease the risk of rebleeding of peptic ulcers. For duodenal ulcers, in particular, intravenous omeprazole may even improve the H. pylori eradication rate of the subsequent triple therapy.     

改良序贯疗法在溃疡活动期根除幽门螺杆菌疗效观察

目的：观察改良序贯疗法在溃疡活动期根除幽门螺杆菌（Hp）的疗效。方法：将确诊为Hp阳性的90例患者分两组,其中标准三联治疗方案45例,奥美拉唑静脉点滴＋克拉霉素＋阿莫西林,每日2次口服,共10d;改良序贯疗法方案45例,前5d奥美拉唑＋左氧氟沙星静脉点滴,后5d奥美拉唑静脉点滴＋阿莫西林＋甲硝唑,每日2次口服。疗程结束后4周复查Hp检测。结果：三联疗法组Hp根除率为80.0%（36/45）,序贯疗法组Hp根除率为95.6%（43/45）,两组疗效比较,差异具有统计学意义（P〈0.05）。结论：改良序贯疗法在根除溃疡活动期Hp感染疗效上明显优于标准三联疗法,可以达到尽早、尽快、有效地根除Hp的目的。     

Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease

OBJECTIVE: Furazolidone, an old but cheap antibiotic, was shown to be a good alternative to metronidazole in triple therapy for Helicobacter pylori eradication in areas where metronidazole resistant bacteria are common, but randomized studies are lacking. AIM: A randomized controlled trial to determine the efficacy and safety of furazolidone compared to metronidazole in classic quadruple therapy for eradication of H. pylori infection in duodenal ulcer patients. METHODS: Patients with endoscopically proven duodenal ulcer and positive urease test were randomized to receive ranitidine 300 mg, amoxycillin 1000 mg and bismuth subcitrate 240 mg b.d, with either furazolidone 200 mg b.d (RABF), or metronidazole 500 mg b.d. (RABM) for 2 weeks. Compliance and side-effects were monitored and recorded by table diary. H. pylori eradication was assessed at least 4 weeks after the completion of therapy with 14C-urea breath test. RESULTS: A total of 106 patients were enrolled and 101 (59 male, 42 female, mean age=40 +/- 11 years) completed the study. Endoscopic findings and demographic data were comparable in both groups. Intention-to-treat eradication rates were 75% and 55% (P=0.03) and per protocol eradication rates were 82 and 56% (P=0. 006) in the RABF and RABM groups, respectively. Side-effects were reported by 13 patients (27%) in the RABF group (one stopped treatment) compared to five patients (10%) in the RABM group (P=0. 04). CONCLUSION: Quadruple therapy containing furazolidone, instead of metronidazole, results in a significantly higher H. pylori eradication rate in Iranian duodenal ulcer patients.     

三九胃泰四联疗法治疗消化性溃疡及根除幽门螺杆菌的多中心临床研究

目的：观察含三九胃泰的四联疗法对消化性溃疡的治疗作用及根除幽门螺杆菌（Hp)的效果。方法：经胃镜确诊的102例消化性溃疡患者随机分成3组，试验组（A组，48例）给予三九胃2.5 雷尼替丁150mg 阿莫西林500mg 甲硝唑400mg,bid；对照组1（B1组，31例）给予铋剂220mg 雷尼替丁150mg 阿莫西林500mg 甲硝唑400mg,bid；对照组2（B2组，23例）给予雷尼替丁150mg 阿莫西林500mg 甲硝唑400mg,bid；以上药物除抗菌药只服用2周外，其余药物服至6周末疗程结束，第7周复查胃镜和／或^13C呼气试验。结果：溃疡总愈合率A组、B1组、B2组分别为90．9％，100％和86．4％，S2获得率分别为68．2％，73．1％和45．5％，Hp根除率分别为76．1％，73．3％，52．6％，症状缓解率大致相似，3组均无明显不良反应发生。结论：雷尼替丁三联疗法加用三九胃泰治疗消化性溃疡，可使S2获得率增加，同时Hp根除率上升，其效果与加用铋剂效果相近，临床观察无明显不良反应。     

One-week triple therapy with esomeprazole provides effective eradication of Helicobacter pylori in duodenal ulcer disease

BACKGROUND: Esomeprazole is the first proton pump inhibitor to be developed as an optical isomer for the treatment of acid-related diseases. METHODS: Four hundred and forty eight duodenal ulcer patients with Helicobacter pylori infection, confirmed by 13C-urea breath test (UBT), and no current ulcer, were randomised to double-blind treatment with esomeprazole 20 mg twice daily (b.d.) (n=224) or omeprazole 20 mg b.d. (n=224), in combination with amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. for 1 week (EAC and OAC, respectively). A negative UBT at both 4 and 8 weeks after completing therapy indicated successful H. pylori eradication. RESULTS: Intention-to-treat (ITT) analysis comprised 400 patients (EAC, n=204; OAC, n=196) and per protocol (PP) analysis 377 patients (EAC, n=192; OAC, n=185). Eradication rates (95% confidence intervals) for ITT and PP populations were: EAC, 90% (85-94%) and 91% (86-94%); OAC, 88% (82-92%) and 91% (86-95%). Between-group differences in eradication rates were not statistically significant. Both regimens were well tolerated, with an adverse event profile and frequency typical of proton pump inhibitor plus antibiotic combination therapy. CONCLUSIONS: Esomeprazole-based triple therapy for 1 week is highly effective in eradicating H. pylori infection in duodenal ulcer disease, offers comparable efficacy to omeprazole-based therapy, and is well tolerated.     

Helicobacter pylori infection in peptic ulcer haemorrhage

In this overview, medical advice for routine clinical practice regarding peptic ulcer haemorrhage (PUH) is given, based on the extensive literature about Helicobacter pylori and the controversial results about the interaction of H. pylori infection and nonsteriodal anti-inflammatory drug (NSAID) use. PUH remains an important emergency situation with an incidence between 32 and 51/100 000 persons per year. There is a high association between H. pylori infection and peptic ulcer disease. The association between H. pylori infection and PUH is less clear, but a strong argument for the aetiological role is the fact that eradication of H. pylori decreases recurrence of bleeding. NSAID use is another important risk factor for PUH. H. pylori infection and NSAID use seem to act independently, although some studies show a synergistic interaction while other studies report that H. pylori is protective against the development of PUH in NSAID users. All patients with PUH should be tested for H. pylori infection, regardless of the use of NSAIDs. Because invasive tests are less sensitive in PUH patients, negative tests in patients with no other risk factors should be confirmed by serology or urea breath test (UBT). Eradication therapy with a proton pump inhibitor or ranitidine bismuth citrate-based triple therapy should be given to all H. pylori- positive patients. Only for nonaspirin–NSAID users does the effect of eradication therapy on the healing of gastric ulcers remain controversial, but currently we also advise eradication of H. pylori in this subgroup. After eradication therapy, acid-suppressant therapy is advised to heal the ulcer. The success of eradication should always be confirmed because of the risk of recurrence of peptic ulcer disease and bleeding in H. pylori- infected patients.     

雷贝拉唑三联疗法治疗幽门螺杆菌阳性消化性溃疡疗效观察

目的探讨雷贝拉唑三联疗法治疗幽门螺旋杆菌阳性消化性溃疡的临床疗效,并与奥美拉唑三联疗法治疗的结果进行对比研究。方法选择幽门螺旋杆菌阳性消化性溃疡患者78例,随机分为观察组40例与对照组38例,观察组患者应用雷贝拉唑联合克拉霉素和阿莫西林三联疗法治疗,对照组患者应用奥美拉唑联合克拉霉素和阿莫西林三联疗法治疗,对比两组患者的临床疗效。结果观察组患者经治疗后总有效率为97．5％,对照组为81．6％,观察组疗效显著优于对照组,差异有统计学意义（P〈0．05）。观察组HP转阴37例,占92．5％,对照组HP转阴35例,占92．1％,两组HP阴转率比较差异无统计学意义（P〉0．05）。结论雷贝拉唑三联疗法治疗幽门螺杆菌阳性消化性溃疡临床效果好,在抑制胃酸分泌及缓解疼痛等方面优于奥美拉唑三联疗法。     

Meta-analysis: Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer

AIM: To perform a meta-analysis comparing the efficacy of Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. METHODS: A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. RESULTS: In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori eradication therapy group was 4.5%, compared with 23.7% in the non-eradication therapy group without long-term antisecretory therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09-0.37; 'number needed to treat' (NNT), 5; 95% CI, 4-8]. In the second meta-analysis, the re-bleeding rate in the H. pylori eradication therapy group was 1.6%, compared with 5.6% in the non-eradication therapy group with maintenance antisecretory therapy (odds ratio, 0.25; 95% CI, 0.08-0.76; NNT, 20; 95% CI, 12-100). When only patients with successful H. pylori eradication were included, the re-bleeding rate was 1%. CONCLUSIONS: The treatment of H. pylori infection is more effective than antisecretory non-eradication therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and eradication therapy should be prescribed to infected patients.     

Rabeprazole-based therapy in Helicobacter pylori eradication

Rabeprazole's favourable pharmacodynamic profile is a result of its rapid onset and its 24-h control of gastric parietal secretion. These qualities, and its antimicrobial properties, make it particularly effective in the treatment of Helicobacter pylori ( H. pylori ), which is a short course of treatment compared to other conditions treated with proton pump inhibitors. Recently completed trials in combination with amoxicillin, clarithromycin and metronidazole for 7 days achieved high eradication of H. pylori . An additional study assessing the efficacy of combined rabeprazole and antibiotic treatments of 3, 7, and 10 days' duration vs. FDA-approved 10-day omeprazole triple therapy is under way to address the possibility of shorter duration therapies in the USA.     

序贯疗法与四联疗法治疗幽门螺杆菌阳性消化性溃疡的疗效比较

目的比较序贯疗法与四联疗法治疗幽门螺杆菌（Hp）阳性消化性溃疡疗效及Hp根除率。方法采用前瞻性的方法,将120例消化性溃疡患者按单双号随机分为治疗组与对照组各60例,治疗组采用序贯疗法,对照组采用四联疗法。结果治疗组与对照组总有效率分别为86．7％和91．7％,两组比较差异无统计学意义（P〉0．05）。经检测,治疗组Hp根除率90．0％,对照组Hp根除率85．0％,两组Hp根除率差异无统计学意义（P〉0．05）。结论序贯疗法治疗消化性溃疡的有效率和Hp根除率较四联疗法无明显差异,可作为Hp感染初治患者的一线方案。     

Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users

Aim : To evaluate whether eradication of Helicobacter pylori prevents peptic ulcer in non‐steroidal anti‐inflammatory drug users by means of a meta‐analysis. Material and methods : A systematic search was performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register and the AGA congress. Randomized trials comparing H. pylori eradication vs. non‐eradication or eradication vs. a proton pump inhibitor in patients receiving a non‐steroidal anti‐inflammatory drug were selected. Results : Five studies and 939 patients were included in the analysis; 34 of 459 (7.4%) patients developed a peptic ulcer in the eradicated group vs. 64 of 480 (13.3%) in the control group. The odds ratio was 0.43 (95% confidence interval: 0.20–0.93). Sub‐analyses showed a significant reduction of risk for non‐steroidal anti‐inflammatory drug‐naive (odds ratio = 0.26; 95% confidence interval: 0.14–0.49) but not for previously treated patients (odds ratio = 0.95, 95% confidence interval: 0.53–1.72). Two studies with a total of 385 patients compared eradication vs. a proton pump inhibitor; five of 196 (2.6%) developed a peptic ulcer in the eradicated group vs. zero of 189 (0%) in the proton pump inhibitor group (odds ratio = 7.43; 95% confidence interval: 1.27–43.6). Conclusion : Helicobacter pylori eradication reduces the incidence of peptic ulcer in the overall population receiving non‐steroidal anti‐inflammatory drugs. It appears to be especially effective when performed in non‐steroidal anti‐inflammatory drug‐naïve patients. Nonetheless, eradication seems less effective than treatment with a maintenance proton pump inhibitor for preventing non‐steroidal anti‐inflammatory drug‐associated ulcers.     

High rate of Helicobacter pylori eradication with sequential therapy in elderly patients with peptic ulcer: a prospective controlled study

BACKGROUND: Helicobacter pylori eradication rates with triple therapies are decreasing, and few data in elderly patients are available. A 10-day sequential regimen succeeded in curing such H. pylori infection in unselected patients. AIM: To compare this sequential regimen and the standard triple therapy for H. pylori eradication in geriatric patients with peptic ulcer. METHODS: Overall, 179 H. pylori-infected patients with peptic ulcer were enrolled (mean age: 69.5 years; range: 65-83). Patients were randomized to 10-day sequential therapy (rabeprazole 20 mg b.d. plus amoxicillin 1 g b.d. for the first 5 days, followed by rabeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg, all b.d., for the remaining 5 days) or standard 7-day triple regimen (rabeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1 g, all b.d.). Helicobacter pylori status was assessed by histology and rapid urease test at baseline and 4-6 weeks after completion of treatment. RESULTS: The sequential regimen achieved eradication rates significantly higher in comparison with the standard regimen at both intention-to-treat (94% vs. 80%; P = 0.008) and per-protocol (97% vs. 83%; P = 0.006) analyses. In both treatment groups, compliance to the therapy was high (> 95%), and the rate of mild side-effects was similarly low (< 12%). At repeated upper endoscopy, peptic ulcer lesions were healed in 97% patients, without a statistically significant difference between the sequential regimen and the standard triple therapy. CONCLUSIONS: In elderly patients with peptic ulcer disease, the 10-day sequential treatment regimen achieved significantly higher eradication rates in comparison with standard triple therapy.     

Duodenal ulcer relapse after eradication of Helicobacter pylori

Thirty-six patients with healed duodenal ulcers, 27 infected with Helicobacter pylori and nine uninfected, were followed for up to 12 months to determine the rate of ulcer relapse. Eight patients withdrew over the follow up period. At one year, 15 of 20 (75%) infected patients and one of eight (13%) uninfected patients had relapsed, p less than 0.05. Eradication of H pylori favourably influences the natural history of duodenal ulcer recurrence. Significant patient morbidity may be prevented by using measures to eradicate H pylori during or after duodenal ulcer healing.     

四联疗法治疗幽门螺杆菌阳性消化性溃疡疗效观察

目的观察四联疗法治疗HP阳性的十二指肠溃疡、胃溃疡HP根除率及疗效。方法经胃镜和快速尿素酶方法确诊的HP阳性十二指肠溃疡和胃溃疡共247例。予雷贝拉唑20 mg,2次/日+胶体果胶铋0.2,2次/日+克拉霉素0.5,2次/日+甲硝唑0.4,2次/日,口服一周,继而连服雷贝拉唑20 mg,一次/日共5周。疗程结束四周后胃镜及快速尿素酶试验复查。结果随访成功196例,HP总根除率81.6%,其中十二指肠溃疡根除率86%,胃溃疡根除率67.4%,溃疡病总有效率88.3%,其中十二指肠溃疡有效率89.3%,胃溃疡有效率84.8%,两组比较差异显著(P0.01)。结论含雷贝拉唑的四联疗法,对HP阳性的十二指肠溃疡HP根除及疗效优于HP阳性的胃溃疡。     

雷贝拉唑、阿莫西林和硫糖铝根除幽门螺杆菌的疗效观察

目的观察雷贝拉唑、阿莫西林和硫糖铝三联疗法对根除幽门螺杆菌(HP)的疗效。方法将95例经胃镜检查确诊为十二指肠溃疡活动期,并经快速尿素酶试验和14C-尿素呼气试验,确定为HP阳性的患者分为两组。A组以雷贝拉唑0.01 g(qd),阿莫西林1 g(bid)和硫糖铝1 g(qid)治疗2周;B组以雷贝拉唑0.01 g(qd),阿莫西林1 g(bid)和克拉霉素0.5 g(bid)治疗2周。于用药结束后,第28天复查胃镜,观察溃疡愈合情况并检查HP。结果A组的HP根除率为91.5%,B组为93.8%,两组无显著性差异(P>0.05);A组溃疡的愈合率(93.6%)稍高于B组(89.6%),但无显著性差异(P>0.05)。结论雷贝拉唑、阿莫西林和硫糖铝三联疗法能有效地根除HP,溃疡愈合率高,安全且耐受性好,是一种较理想的HP根除新方案。