H pylori eradication with PPI-triple therapy in clinical practice: Factors of failure

On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

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M1126 Effectiveness of a 10-Day Triple Therapy Combining Potent Acid Inhibition With Amoxicillin and Metronidazole for H. pylori Eradication in Clinical Practice. A Pilot Study

Gastroenterology ◽

10.1016/s0016-5085(10)61552-1 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-337 ◽

Cited By ~ 1

Author(s):

Jordi Sánchez-Delgado ◽

Pilar García-Iglesias ◽

Xavier Calvet ◽

Manuel Castro-Fernandez ◽

Felipe Bory ◽

...

Keyword(s):

Clinical Practice ◽

Pilot Study ◽

Triple Therapy ◽

Acid Inhibition ◽

H Pylori

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European registry on Helicobacter pylori management (Hp-EuReg) as a tool to evaluate and improve clinical practice in Moscow

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.02.000567 ◽

2020 ◽

Vol 92 (2) ◽

pp. 12-18

Author(s):

D. S. Bordin ◽

I. N. Voynovan ◽

Yu. V. Embutnieks ◽

O. P. Nyssen ◽

Francis Megraud ◽

...

Keyword(s):

Helicobacter Pylori ◽

Clinical Practice ◽

Proton Pump Inhibitor ◽

Triple Therapy ◽

Proton Pump ◽

Antigen Test ◽

Stool Antigen Test ◽

Standard Triple Therapy ◽

Stool Antigen ◽

H Pylori

Continuous evaluation of the actual clinical practice of diagnosis and treatment of Helicobacter pylori is crucial in order to provide the best standard of care and to compare health outcomes with expert recommendations. Aim:to evaluate the effectiveness of the standard triple therapy (amoxicillin, clarithromycin, a proton pump inhibitor) and the standard triple therapy plus bismuth tripotassium dicitrate. Materials and methods.Observational, prospective, multicenter study, carried out in one single Russian centre A.S. Loginov Moscow Clinical Scientific Center as part of the Hp-EuReg. Patients were included from 2013 to November 2019 by Russian gastroenterologists. Results.A total of 647 patients were collected and 330 were administered either standard triple therapy ((amoxicillin, clarithromycin, a proton pump inhibitor) or standard triple therapy plus bismuth tripotassium dicitrate. Invasive methods is dominates in the initial diagnosis of H. pylori: the frequency of use of the quick urease test decreased from 50% in 2013 to 31% in 2019. Serology was used in 27.9%. There has been an increase in the use of the13C-urea breath test from 13% in 2013 to 31% in 2019. The histological method (7.5%) and the stool antigen test (3.2%) were used less frequently. For eradication control non-invasive methods are mostly used:13C-UDT (82.7%) and the stool antigen test (14.4%). The effectiveness of standard triple therapy (mITT) was 68% with a 7-day course, 79% with a 10-day course, and 70% with a 14-day course. Combination of bismuth and standard triple therapy eradicates H. pylori (mITT) in 63%, 75% and 89%, respectively. Conclusion.An improvement in the clinical practice of managing patients with H. pylori infections has been noted. The standard triple therapy in combination with bismuth tripotassium dicitrate, prescribed for 14 days, is more effective.

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The key to successful eradication of H. pylori, using lansoprazole or rabeprazole based triple therapy, is clarithromycin resistance, not CYP2C19 polymorphism

Gastroenterology ◽

10.1016/s0016-5085(01)82921-8 ◽

2001 ◽

Vol 120 (5) ◽

pp. A587-A587

Author(s):

I MIKI ◽

N AOYAMA ◽

T SAKAI ◽

D SHIRASAKA ◽

S EBARA ◽

...

Keyword(s):

Triple Therapy ◽

Clarithromycin Resistance ◽

Cyp2c19 Polymorphism ◽

H Pylori

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Moxifloxacin Based Triple Therapy as Alternative to Standard Therapy in Helicobacter Pylori Eradication.

Anti-Infective Agents ◽

10.2174/2211352518999200925154501 ◽

2020 ◽

Vol 18 ◽

Author(s):

Mohammed Hussien Ahmed ◽

Sherief Abd-Elsalam ◽

Aya Mohammed Mahrous

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Therapy Group ◽

Low Cost ◽

High Rate ◽

Helicobacter Pylori Eradication ◽

Treatment Regimens ◽

Group A ◽

H Pylori ◽

Group B

Introduction: Helicobacter pylori eradication remains a problematic issue. We are in an urgent need for finding a treatment regimen that achieves eradication at a low cost and less side effect. Recent published results showing a high rate of resistance and with clarithromycin-based treatment regimens. The aim of the study was to compare moxifloxacin therapy and classic clarithromycin triple therapy in H. pylori eradication. Methods: This was a pilot study that enrolled 60 patients with helicobacter pylori associated gastritis. Diagnosis was done by assessment of H. pylori Ag in the stool. The patients were randomly assigned to receive either moxifloxacin based therapy (Group A), or clarithromycin based therapy (Group B) for two weeks. We stopped the treatment for another two weeks then reevaluation for cure was done. Results: 90 % of patients had negative H. pylori Ag in the stool after 2 weeks of stoppage of the treatment in group A versus 66.7 % in Group B. None of the patients in both groups had major side effects. Conclusion: Moxifloxacin-based therapy showed higher eradication power and less resistance when compared to clarithromycin triple therapy.

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Selective killing of Helicobacter pylori with pH-responsive helix–coil conformation transitionable antimicrobial polypeptides

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1710408114 ◽

2017 ◽

Vol 114 (48) ◽

pp. 12675-12680 ◽

Cited By ~ 36

Author(s):

Menghua Xiong ◽

Yan Bao ◽

Xin Xu ◽

Hua Wang ◽

Zhiyuan Han ◽

...

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Helical Structure ◽

Commensal Bacteria ◽

Gastric Ulcers ◽

Normal Tissues ◽

Minimal Toxicity ◽

Antimicrobial Polypeptides ◽

H Pylori ◽

Drug Resistant Strains

Current clinical treatment of Helicobacter pylori infection, the main etiological factor in the development of gastritis, gastric ulcers, and gastric carcinoma, requires a combination of at least two antibiotics and one proton pump inhibitor. However, such triple therapy suffers from progressively decreased therapeutic efficacy due to the drug resistance and undesired killing of the commensal bacteria due to poor selectivity. Here, we report the development of antimicrobial polypeptide-based monotherapy, which can specifically kill H. pylori under acidic pH in the stomach while inducing minimal toxicity to commensal bacteria under physiological pH. Specifically, we designed a class of pH-sensitive, helix–coil conformation transitionable antimicrobial polypeptides (HCT-AMPs) (PGA)m-r-(PHLG-MHH)n, bearing randomly distributed negatively charged glutamic acid and positively charged poly(γ-6-N-(methyldihexylammonium)hexyl-l-glutamate) (PHLG-MHH) residues. The HCT-AMPs showed unappreciable toxicity at physiological pH when they adopted random coiled conformation. Under acidic condition in the stomach, they transformed to the helical structure and exhibited potent antibacterial activity against H. pylori, including clinically isolated drug-resistant strains. After oral gavage, the HCT-AMPs afforded comparable H. pylori killing efficacy to the triple-therapy approach while inducing minimal toxicity against normal tissues and commensal bacteria, in comparison with the remarkable killing of commensal bacteria by 65% and 86% in the ileal contents and feces, respectively, following triple therapy. This strategy renders an effective approach to specifically target and kill H. pylori in the stomach while not harming the commensal bacteria/normal tissues.

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Helicobacter pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy: an open randomized clinical trial

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032005000200009 ◽

2005 ◽

Vol 42 (2) ◽

pp. 111-115 ◽

Cited By ~ 9

Author(s):

Laura Cidrão Frota ◽

Maria do Perpétuo Socorro Saldanha da Cunha ◽

Carlos René Lima Luz ◽

Antonio Haroldo de Araujo-Filho ◽

Luciano A. S. Frota ◽

...

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Protocol Analysis ◽

Urea Breath Test ◽

Test Results ◽

Suitable Alternative ◽

Helicobacter Pylori Eradication ◽

Helicobacter Pylori Treatment ◽

H Pylori ◽

To Receive

BACKGROUND: Optimal anti-Helicobacter pylori treatment has not yet been established. AIM: To evaluate H. pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy in northeastern of Brazil. PATIENTS AND METHODS: One hundred and four patients with H. pylori infection, as determined by rapid urease testing and histology, were randomly assigned to receive either: lansoprazole (30 mg q.d.), tetracycline (500 mg q.i.d.), and furazolidone (200 mg t.i.d.) for 7 days (LTF; n = 52); or lansoprazole (30 mg b.i.d.) and amoxicillin (1 g b.i.d.) for 1 week, plus azithromycin (500 mg q.d.) for the first 3 days (LAAz; n = 52). H. pylori eradication was assessed 3 months following completion of therapy by means of rapid urease testing, histology and a 14C-urea breath test. RESULTS: H. pylori eradication was achieved in 46 of 52 (88.4%, 95% CI: 77.5%-95.1%) patients in LTF group and in 14 of 52 (26.9%, 95% CI: 16.2%-40,1%) patients in LAAz group. On a per-protocol analysis, eradication rates were 91.8% (95% CI: 81.4%-97.3%) and 28.5% (95% CI: 17.2%-42.3%), respectively in LTF and LAAz groups. CONCLUSION: The LAAz regimen yielded unacceptably low eradication rates. On the other hand, the LTF scheme represents a suitable alternative for H. pylori eradication.

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