Omeprazole Therapy for Helicobacter pylori Infection

To determine whether omeprazole eradicates Helicobacter pylori infection of the gastric antrum, six adolescents and one adult with H. pylori colonization of the antrum were entered into a clinical, open trial of medical therapy. Histologic evidence of antral gastritis and three complementary methods to document H. pylori colonization of the stomach (silver stain, urease testing, and culture of antrum) were obtained before and after an 8-week course of omeprazole. In vitro susceptibility to omeprazole and restriction endonuclease analysis were performed on H. pylori isolates obtained from patients before and after omeprazole therapy. Each of the seven patients treated with omeprazole had continued active inflammation in the antrum and one or more features indicative of persisting H. pylori colonization. Minimum inhibitory concentrations and DNA fingerprints of H. pylori isolated after therapy were identical to those of the pre-treatment bacterial isolates in each of the four subjects examined. We conclude that omeprazole therapy alone did not eradicate H. pylori infection of the human antrum. Continued bacterial colonization was not related to either acquired bacterial resistance to the drug or reinfection of the stomach with a different H. pylori strain.     

Omeprazole therapy for Helicobacter pylori infection.

To determine whether omeprazole eradicates Helicobacter pylori infection of the gastric antrum, six adolescents and one adult with H. pylori colonization of the antrum were entered into a clinical, open trial of medical therapy. Histologic evidence of antral gastritis and three complementary methods to document H. pylori colonization of the stomach (silver stain, urease testing, and culture of antrum) were obtained before and after an 8-week course of omeprazole. In vitro susceptibility to omeprazole and restriction endonuclease analysis were performed on H. pylori isolates obtained from patients before and after omeprazole therapy. Each of the seven patients treated with omeprazole had continued active inflammation in the antrum and one or more features indicative of persisting H. pylori colonization. Minimum inhibitory concentrations and DNA fingerprints of H. pylori isolated after therapy were identical to those of the pre-treatment bacterial isolates in each of the four subjects examined. We conclude that omeprazole therapy alone did not eradicate H. pylori infection of the human antrum. Continued bacterial colonization was not related to either acquired bacterial resistance to the drug or reinfection of the stomach with a different H. pylori strain.     

Factors that May Affect Treatment Outcome of Triple Helicobacter pylori Eradication Therapy with Omeprazole, Amoxicillin, and Clarithromycin

Factors affecting Helicobacter pylori eradication rate with omeprazole (OME), clarithromycin (CL), and amoxicillin (AMO) have not been extensively studied. We have investigated the effect of age, sex, smoking, ulcer disease, compliance with therapy, H. pylori colonization density, degree and activity of antral gastritis, the coexistence of corpus gastritis, and the presence of lymphoid follicles on H. pylori eradication rate. We studied 80 consecutive H. pylori-positive patients, with duodenal ulcer (N = 35) or nonulcer dyspepsia (N = 45) treated with OME 20 mg, CL 500 mg, and AMO 1 g, each given twice daily for 10 days. H. pylori was eradicated in 71/80 (88.8%, 95% CI 82–96%) patients. The regimen failed to eradicate the only strain (1.8%, 95% CI 0–5.2%) that was clarithromycin resistant. Multivariate discriminant analysis showed that two histological variables (Wilks = 0.74, ² = 23.41, df = 2, P < 0.001), absence of lymphoid follicles in routine gastric biopsies (F = 13.63, P < 0.001) and coexistence of antral and body gastritis (F = 13.68, P < 0.001), significantly increased H. pylori eradication rate. No other factor examined predicted H. pylori eradication with this regimen. Our data suggest that body gastritis is a positive and presence of lymphoid follicles in routine gastric biopsies is a negative predictive factor of treatment outcome with the omeprazole, clarithromycin, and amoxicillin regime.     

Omeprazole enhances efficacy of triple therapy in eradicating Helicobacter pylori.

Triple therapy has been recommended as the most effective treatment for Helicobacter pylori eradication. Despite achieving a comparatively high eradication result, however, around 10% of patients still fail to be cured. Omeprazole can enhance efficacy of single and double antibiotic protocols and is particularly effective when combined with clarithromycin and a nitroimidazole. This study examined the effect of combining triple therapy with omeprazole. A prospective, randomised, unblinded, single centre trial was carried out on consecutive patients with symptoms of dyspepsia and H pylori infection confirmed by rapid urease test, microbiological culture, and histological assessment. Patients were given a five times/day, 12 day course of colloidal bismuth subcitrate chewable tablets (108 mg), tetracycline HCl (250 mg), and metronidazole (200 mg) with either 20 mg omeprazole twice daily (triple therapy+omeprazole) or 40 mg famotidine (triple therapy+famotidine) at night. Compliance and side effects were determined using a standard questionnaire form. One hundred and twenty five of 165 triple therapy+omeprazole patients and 124 of 171 triple therapy+famotidine patients returned for rebiopsy four weeks after completion of treatment. Significantly more triple therapy+omeprazole patients achieved eradication 122 of 125 (97.6%) as assessed by negative urease test, culture, and histological assessment, when compared with 110 of 124 (89%) triple therapy+famotidine patients (p = 0.006; chi 2). There were 30 triple therapy+omeprazole (24%) and 26 triple therapy+famotidine (21%) patients with de novo metronidazole resistant H pylori included in the study. Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seemed to subside earlier in those taking omeprazole. Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups. A 12 days regimen of triple therapy with omeprazole is more effective in achieving H pylori eradication than is triple therapy plus famotidine. Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 day, low dose triple therapy enhances eradication to over 97% whether the H pylori is metronidazole sensitive or resistant.     

Long-Term Omeprazole Therapy Does Not Affect Helicobacter pylori Status in Most Patients

Fifty-one patients were treated with 20-60 mg omeprazole for reflux oesophagitis resistant to H₂-blocker therapy during a mean of 49 months of follow-up. With use of a standardized enzyme-linked immunosorbent assay technique specific IgG and IgG Helicobacter pylori antibodies were determined in serum obtained at the start of therapy and at the most recent visit. At the start of therapy 26 patients (51%) had evidence of H. pylori infection, as demonstrated by increased IgG and IgA antibody levels. During follow-up, 4 of these 26 patients (15%) became H. pylori seronegative. It is concluded that long-term treatment with omeprazole has no effect on H. pylori status in most patients.     

奥美拉唑、羟氨苄青霉素和小剂量呋喃唑酮混悬液根除胃Hp感染

目的探讨奥美拉唑、羟氨苄青霉素和小剂量呋喃唑酮混悬液对幽门螺杆菌（Hp）的根除率方法Hp相关的十二指肠溃疡和慢性胃炎患者136例，随机分为3组．第1组（n＝46）用奥美拉唑、羟氨等青霉素和小剂量呋喃唑酮混悬液三联治疗1wk．第2组（n＝45）用同样的药物和剂量2wk．第3组（n＝45）用胶体铋剂、羟氨苄青霉素和灭滴灵三联治疗2wk．Hp检测根据尿素酶试验和组织Warthin-Starry银染色法检查结果第1，2和3组的Hp根除率分别为88．9％，955％和71．4％．第1组与第3组，第2组与第3组比较差异均有显著性（P＜0．05），而第1组与第2组比较无明显差异．第3组患者出现不良反应者比前两组明显增多．结论奥美拉唑、羟氨苄青霉素和小剂量呋喃唑酮混悬液联合治疗Hp感染，具有根除率高和副作用少的优点．     

Omeprazole attenuates neutrophil-endothelial cell adhesive interaction induced by extracts of Helicobacter pylori

In this study, the influence of omeprazole on the adhesive activity of neutrophils, provided by an extract of Helicobacter pylori, was determined. Human neutrophils were collected from peripheral blood and labelled with a fluorochrome. Helicobacter pylori (NCTC 11637) was cultured and its water extract was obtained by centrifugation of the bacterial suspension. Neutrophils were incubated with the extract in a plastic plate. Percentage adherence was calculated by measuring the fluorescence of floating and adherent cells. Rat mesenteric venule was prepared on an intravital microscope and the number of neutrophils which adhered to venular endothelium was counted. Neutrophil adherence to the plastic plate was increased by the presence of H. pylori extract. Pretreatment with omeprazole significantly decreased this adherence in a dose-dependent manner (10(-6)-10(-4)mol/L). Neutrophil adherence to the mesenteric venule was also increased by H. pylori extract and significantly inhibited by omeprazole. These results indicate that the neutrophil-endothelial adhesive interaction is inhibited by omeprazole, suggesting that omeprazole prevents neutrophil recruitment to the gastric mucosa associated with H. pylori infection.     

Medium-or High-Dose Omeprazole Plus Amoxicillin Eradicates Helicobacter pylori in Gastric Ulcer Disease

Objective: To compare the efficacy of two omeprazole/amoxicillin regimens concerning Helicobacter pylori eradication, ulcer healing, pain relief, and safety in patients with gastric ulcer disease. Methods: In a prospective, single-blind, single-center study, 70 patients with active, H. Pylori -positive (histology and/or culture) gastric ulcers were randomly treated with either omeprazole 20 mg b.i.d . plus amoxicillin 1 g b.i.d . (group I; n = 35) or with omeprazole 40 mg b.i.d . plus amoxicillin 1 g b.i.d . over 2 wk, followed by full dose ranitidine for another 4 wk. Patients were investigated clinically and endoscopicaily prior to treatment and after 6 wk, including the assessment of H. pylori status by means of urease test, specific culture, and histology. Results: Patients of group I and II had similar demographic and clinical characteristics. Three patients were lost to follow-up. The overall proportion of H. pylori eradication was 88.1% (group I, 91.2%; group II, 84.8%, p = NS). The ulcer healing rate was 79.1% after 6 wk, 92.5% after 10 wk, and 100% after 6 months, without a statistically significant difference between the study groups. Complete pain relief occurred after a median of 2 days (group I) and 1.5 days (group II, p = NS), respectively. Six patients (9.0%) complained of side effects that led to discontinuation of amoxicillin treatment in three patients (4.5%). Conclusions: Omeprazole plus amoxicillin is a highly effective and well-tolerated therapy regimen to eradicate H. pylori from the gastric mucosa of patients with gastric ulcer disease. In addition, the results clearly suggest that medium- and highdose omeprazole schedules are equally effective with regard to bacterial eradication, ulcer healing, pain relief, and safety in gastric ulcers. Thus, medium- and not high-dose omeprazole plus amoxicillin should be the treatment regimen of first choice to eradicate H. pylori in gastric ulcer disease.     

Omeprazole once or twice daily with clarithromycin and metronidazole for Helicobacter pylori.

BACKGROUND: Triple therapy for one week with omeprazole, clarithromycin and metronidazole (OCM) is accepted worldwide as a first line therapy for Helicobacter pylori eradication. It is unclear whether omeprazole needs to be given once or twice daily. OBJECTIVES: To assess the efficacy and safety of these regimens in a single-centre, Canadian practice. METHODS: Histologically proven H pylori-positive patients were treated for seven days with clarithromycin 250 mg bid and metronidazole 500 mg bid, and randomly allocated to omeprazole 20 mg either once or twice daily in this open, cohort study. Endoscopy with histology (two antrum and two body biopsies, Giemsa stain) was done four weeks or longer after the pills were completed to assess H pylori eradication. RESULTS: Whether omeprazole was given once or twice daily, eradication was high and the same in both arms. All-patients-treated eradication was 85% (39 of 46 in the omeprazole once daily group and 41 of 48 in the omeprazole twice daily group) and intent-to-treat eradication was 80% (39 of 49 in the omeprazole once daily group and 41 of 51 in the omeprazole twice daily group). Side effects were frequently seen, suffered by 65% to 69% of patients treated. However, these were mild and compliance was high, with 94% of patients taking all of their pills. Mild side effects included loose stools, taste disturbance, nausea, headache and upper or lower gastrointestinal gas. Only one patient (1%) from the omeprazole once daily arm stopped taking metronidazole due to excessive perspiring. CONCLUSIONS: In this community practice, OCM triple therapy was effective whether omeprazole was given once or twice daily. For those with financial constraint, omeprazole 20 mg once daily can be considered. The regimens were well tolerated without serious adverse events.     

Medium-Term Results of Oral and Intravenous Omeprazole/Amoxicillin Helicobacter pylori Eradication Therapy

Objectives : The aim of the present study was to examine the effect of the application route of the antibiotic amoxicillin in Helicobacter pylori eradication, using omeprazole/amoxicillin. Methods : In a prospective medium-term study, 31 patients with H. pylori -positive gastroduodenal ulcer disease were treated with a 14-day course of 20 mg omeprazole bid orally, combined with either 1 g amoxicillin tid intravenously (n = 15) or 500 mg amoxicillin six times daily orally (n = 16). Results : H. pylori eradication, defined as negative bacterial findings in urease test, culture, and histology at least 4 wk after cessation of study medication, was achieved in 93% (14/15) of the patients in the first group and in 91% (11/12) of the patients in the second group. To obtain medium-term results, patients in whom H. pylori had been successfully eradicated were investigated with a ¹³C-urea breath test at least 6 months later. Medium-term eradication rates of 91% (10/11 patients) in the first and 100% (10/10 patients) in the second group were observed. Conclusions : In view of the equally high eradication rates obtained by a 14-day course of intravenously administered amoxicillin and an oral therapy of the same length and dosage, during the necessary induction of luminal hypoacidity by the proton pump inhibitor omeprazole, we conclude that the route of administration of amoxicillin does not play a decisive role in bacterial eradication.     

Omeprazole Plus Amoxicillin: Efficacy of Various Treatment Regimens to Eradicate Helicobacter pylori

In five subsequent open clinical studies, 180 patients with Helicobacter pylori (HP)-associated ulcer disease (n = 163) or severe functional dyspepsia (n = 17) requiring therapy were treated with either 40 mg omeprazole plus 4 × 500 mg amoxicillin suspension for 1 wk (group I, n = 35), 2 × 40 mg omeprazole plus 4 × 500 mg amoxicillin for 1 wk (group II, n = 50), 2 × 20 mg omeprazole plus 4 × 500 mg amoxicillin for 2 wk (group III, n = 62), 2 × 20 mg omeprazole (day 1–14) and 4 × 500 mg amoxicillin (day 8–14) (group IV, n = 22) or with 2 × 20 mg omeprazole for 2 wk (group V, n = 11). The HP eradication rates determined with a biopsy urease test, microscopy of a mucosal smear, specific culture, and histology after modified GIEMSA staining in the 5th wk after discontinuation of study medication were 61.3% in group I, 61.7% in group II, 82.8% in group III, 28.6% in group IV, and 0% in group V. Apart from clinical insignificant pharyngeal paresthesias (n = 6), nine patients (5.7%) with combined therapy complained of important side effects (stomatitis: n = 3, diarrhea: n = 3, allergic exanthema: n = 3) that led to termination of amoxicillin treatment in four cases (2.5%). We conclude that omeprazole-enhanced amoxicillin antibiosis is a simple and effective approach to the eradication of HP colonization.     

Transfer of Metronidazole to Gastric Juice: Impact of Helicobacter pylori Infection and Omeprazole

Background: The effects of Helicobacter pylori infection associated with inhibition of gastric acid secretion on the distribution of medications used for H. pylori eradication are poorly understood. The aim of this study was to investigate the effects of a 7-day administration of 20 mg omeprazole on the transfer of metronidazole from plasma to the gastric juice of individuals with and without H. pylori infection. Methods: Fourteen H. pylori-positive and 14 H. pylori-negative male volunteers were enrolled in a study with an open, randomized, two-period crossover design with a 21-day washout period between phases. Plasma, salivary, and gastric juice concentrations of metronidazole in subjects with and without omeprazole treatment were measured with reversed-phase high-performance liquid chromatography/liquid chromatography. Results: Metronidazole peak concentration (C_max     

Omeprazole plus Amoxicillin for Cure of Helicobacter pylori Infection Factors Influencing the Treatment Success

Labenz J, Leverkus F. Börsch G. Omeprazole plus amoxicillin for cure of Helicobacter pylori infection. Factors influencing the treatment success. Scand J Gastroenterol 1994;29:1070-1075.

Background: Omeprazole plus amoxicillin may cure Helicobacter pylori infection. However, the published results vary rather widely, and the factors influencing the treatment success remain unclear.

Methods: Four hundred and twenty-three H. pylori-positive patients were treated with 1- or 2-week regimens comprising 411 mg or 80 mg omeprazole and amoxicillin in 11 prospective protocols. A complete set of data was available for 405 patients (ulcer disease, n = 383; dyspepsia, n = 22) and was submitted to uni- and multi-variate statistical analyses to elucidate the factors affecting the cure rates of the infection; 18 patients were lost to follow-up.

Results: The overall proportion of H. pylori cure was 76%. Insufficient compliance (p < 0.001), a short duration of treatment (p < 0.001), smoking (p = 0.003), and omeprazole pretreatment (p = 0.041) were the significant independent factors predicting treatment failure, whereas advanced age (p = 0.002), high scores of grade and of activity of gastritis (p = 0.035 and p = 0.019. respectively), and gastric ulcer disease (p = 0.058) were independent factors predicting treatment success. Conclusions: Several patient- and therapy-related factors diminish or increase the rate of H. pylori cure obtained by omeprazole/amoxicillin. These should be considered in future studies comparing different treatment regimens for curing H. pylori infection and also when designing treatment regimens applicable for routine clinical practice.     

Omeprazole plus azithromycin and either amoxicillin or tinidazole for eradication of Helicobacter pylori infection

GOALS: To establish whether omeprazole plus azithromycin in association with either amoxicillin or tinidazole is effective in curing Helicobacter pylori infection in dyspeptic patients. BACKGROUND: Many antibiotics in combination with antisecretory drugs have been used in an attempt to find the optimal regimen for eradication of H. pylori. Azithromycin is a macrolide that achieves high concentrations in gastric tissue after a single 500-mg oral dose. STUDY: A total of 160 consecutive symptomatic patients with H. pylori received omeprazole 20 mg twice daily for 1 week, azithromycin 500 mg/d for 3 days, and were randomly assigned to either amoxicillin 1 g twice daily (OAzAm group, n = 80) for 1 week or tinidazole 500 mg twice daily for 3 days (OAzT group, n = 80). H. pylori status was assessed by rapid urease test and histology at entry and by histology and (13)C-urea breath test after the end of the therapy. RESULTS: H. pylori was eradicated in 62.5% of patients in the OAzAm group (intention to treat [ITT] 62.5%) and in 71.2% of patients in the OAzT group (ITT 71.2%). CONCLUSIONS: Although the compliance was excellent and the side effects negligible, the regimens used were partially effective for the eradication of H. pylori.