Different dose of new generation proton pump inhibitors for the treatment of Helicobacter pylori infection: A meta-analysis

The evidence on whether high-dose new generation proton pump inhibitors (PPIs) including rabeprazole and esomeprazole achieve a higher eradication rate of Helicobacter pylori has not been assessed. The primary comparison was eradication and adverse events (AEs) rate of standard (esomeprazole 20 mg bid, rabeprazole 10 mg bid) versus high-dose (esomeprazole 40 mg bid, rabeprazole 20 mg bid) PPIs. Sub-analyses were performed to evaluate the eradication rate between Asians and Caucasians, clarithromycin-resistance (CAM-R) strains, and clarithromycin-sensitivity (CAM-S) strains of different dose PPIs. We conducted a literature search for randomized controlled trials comparing high-with standard-dose esomeprazole and rabeprazole for H. pylori eradication and AEs. A total of 12 trials with 2237 patients were included. The eradication rate of high-dose PPIs was not significantly superior to standard-dose PPIs regimens: 85.3% versus 84.2%, OR 1.09 (0.86–1.37), P = 0.47. The high dose induced more AEs than those of the standard dose, but didn’t reach statistical significance (OR 1.25, 95% CI: 0.99–1.56, P = 0.06). Subgroup analysis showed that the difference in eradication rate of PPIs between high- and standard-dose groups were not statistically significant both in Asians (OR 0.99, 95% CI 0.75–1.32, P = 0.97) and Caucasians (OR 1.27, 95% CI 0.84–1.92, P = 0.26). Furthermore, there were similar eradication rates in CAM-S (OR 1.2; 95% CI 0.58–2.5; P = 0.63) and CAM-R strains (OR 1.08; 95% CI 0.45–2.56; P = 0.87) between the standard-and high-dose groups. High and standard dosages of new generation of the PPIs showed similar H. pylori eradication rates and AEs as well as between Asian versus Caucasian populations, with or without clarithromycin-resistance. However, further studies are needed to confirm.

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The effect of CYP2C19 gene polymorphism on the eradication rate of Helicobacter pylori by proton pump inhibitors-containing regimens in Asian populations: a meta-analysis

Pharmacogenomics ◽

10.2217/pgs-2020-0127 ◽

2021 ◽

Vol 22 (13) ◽

pp. 859-879

Author(s):

Juan Fu ◽

Chang-Feng Sun ◽

Hong-Yan He ◽

Suvash Chandra Ojha ◽

Han Shi ◽

...

Keyword(s):

Helicobacter Pylori ◽

Gene Polymorphism ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Eradication Rate ◽

Meta Analysis ◽

Cochrane Library ◽

Asian Populations ◽

Cyp2c19 Polymorphism ◽

H Pylori

Premise: The effects of proton pump inhibitors (PPI) depend on metabolic enzyme CYP2C19 that has different activity due to gene polymorphism. The purpose of this meta-analysis is to determine the potential effects of CYP2C19 polymorphism on the efficiency of PPI-based treatment. Materials & methods: The PubMed, EMBASE, Cochrane Library, etc. were searched for relevant articles published in English or Chinese from inception to 31 May 2020. Finally, 26 randomized controlled trials and 15 cohort studies met the inclusion criteria and used for the meta-analysis via STATA version 15. Results: Poor metabolizer (PM) genotype Helicobacter pylori eradication rates were highest for Asian individuals receiving triple or quadruple first-line therapy based on PPIs (p < 0.05). CYP2C19 polymorphism could influence H. pylori eradication rate only in Mainland China and Japan (p < 0.05). Conclusion: PM genotype facilitates the elimination of H. pylori in Asian populations. Rabeprazole-, esomeprazole- and pantoprazole-based eradication program was less affected by the CYP2C19 polymorphism.

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Double-Dose, New-Generation Proton Pump Inhibitors Do Not Improve Helicobacter pylori Eradication Rate

Helicobacter ◽

10.1111/j.1523-5378.2007.00556.x ◽

2007 ◽

Vol 12 (6) ◽

pp. 638-642 ◽

Cited By ~ 21

Author(s):

Hyo Sun Choi ◽

Dong Il Park ◽

Sang Jun Hwang ◽

Jung Sik Park ◽

Hong Joo Kim ◽

...

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Eradication Rate ◽

Double Dose ◽

Helicobacter Pylori Eradication ◽

New Generation

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Helicobacter pylori Eradication According to Sequencing-Based 23S Ribosomal RNA Point Mutation Associated with Clarithromycin Resistance

Journal of Clinical Medicine ◽

10.3390/jcm9010054 ◽

2019 ◽

Vol 9 (1) ◽

pp. 54 ◽

Cited By ~ 2

Author(s):

Seung In Seo ◽

Byoung Joo Do ◽

Jin Gu Kang ◽

Hyoung Su Kim ◽

Myoung Kuk Jang ◽

...

Keyword(s):

Helicobacter Pylori ◽

Point Mutation ◽

Ribosomal Rna ◽

Eradication Rate ◽

Point Mutations ◽

Clarithromycin Resistance ◽

Clinically Significant ◽

H Pylori ◽

23S Ribosomal Rna ◽

Significant Point

Background/Aims: Clarithromycin resistance in Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene. We investigated the point mutations in the 23S rRNA genes of patients with clarithromycin-resistant H. pylori and compared the H. pylori eradication rates based on the point mutations. Methods: A total of 431 adult patients with H. pylori infection were recruited in Kangdong Sacred Heart Hospital in 2017 and 2018. Patients who did not have point mutations related to clarithromycin resistance and/or had clinically insignificant point mutations were treated with PAC (proton pump inhibitor, amoxicillin, clarithromycin) for seven days, while patients with clinically significant point mutations were treated with PAM (proton pump inhibitor, amoxicillin, metronidazole) for seven days. H. pylori eradication rates were compared. Results: Sequencing-based detection of point mutations identified four mutations that were considered clinically significant (A2142G, A2142C, A2143G, A2143C). The clarithromycin resistance rate was 21.3% in the overall group of patients. A2143G was the most clinically significant point mutation (84/431, 19.5%), while T2182C was the most clinically insignificant point mutation (283/431, 65.7%). The overall H. pylori eradication rate was 83.7%, and the seven-day PAM-treated clarithromycin-resistance group showed a significantly lower eradication rate than the seven-day PAC-treated nonresistance group (ITT; 55.4% (51/92) vs. 74.3% (252/339), p = 0.001, PP; 66.2% (51/77) vs. 88.4% (252/285), p = 0.0001). Conclusions: There were significantly lower eradication rates in the patients with clarithromycin-resistant H. pylori when treated with PAM for seven days. A future study comparing treatment regimens in clarithromycin-resistant H. pylori-infected patients may be necessary.

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Su1681 Meta-Analysis of Studies Comparing the First and New Generation Proton Pump Inhibitors in the Eradication of Helicobacter pylori

Gastroenterology ◽

10.1016/s0016-5085(12)61825-3 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-481 ◽

Cited By ~ 1

Author(s):

Adrian G. McNicholl ◽

Pablo M. Linares ◽

Olga Perez Nyssen ◽

Xavier Calvet ◽

Javier P Gisbert

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis ◽

New Generation

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The Current Strategy of Helicobacter pylori Eradication

Korean Journal of Medicine ◽

10.3904/kjm.2021.96.1.13 ◽

2021 ◽

Vol 96 (1) ◽

pp. 13-21

Author(s):

Yong Hwan Kwon

Keyword(s):

Helicobacter Pylori ◽

Clinical Practice ◽

Antimicrobial Resistance ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Eradication Rate ◽

Meta Analysis ◽

Cure Rate ◽

Helicobacter Pylori Eradication ◽

H Pylori

Helicobacter pylori (H. pylori) is the main cause of most gastroduodenal diseases. Triple therapy including two antibiotics, amoxicillin and clarithromycin, and a proton pump inhibitor given for a week has been recommended as the treatment of choice since the revision of the Korean H. pylori Clinical Practice Guidelines in 2013. However, antimicrobial resistance significantly decreased the cure rate of H. pylori eradication to 63.9%. Thus, the new H. pylori treatment regimen would be needed to increase the eradication rate in Korea. Recently, the update of clinical practice guideline for treatment of H. pylori was developed by conducting a meta-analysis. In this review, the recommended H. pylori eradication regimen in current 2020 guideline will be discussed.

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Comparative Effect of Proton-Pump Inhibitors on the Success of Triple and Quadruple Therapy for Helicobacter pylori Infection

Digestive Diseases ◽

10.1159/000504909 ◽

2020 ◽

Vol 38 (5) ◽

pp. 408-414 ◽

Cited By ~ 1

Author(s):

Doron Boltin ◽

Zohar Levi ◽

Rachel Gingold-Belfer ◽

Hemda Schmilovitz-Weiss ◽

Tzippy Shochat ◽

...

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Treatment Success ◽

Helicobacter Pylori Infection ◽

Comparative Effect ◽

Quadruple Therapy ◽

13C Urea Breath Test ◽

H Pylori ◽

Current Guidelines

Introduction: Suppression of gastric acid secretion with proton-pump inhibitors (PPI) is an integral part of the treatment of Helicobacter pylori infection. Esomeprazole has been shown to be superior to other PPIs when used in the context of triple therapy; however, comparative data for PPI efficacy in quadruple therapy are lacking. Current guidelines recommend H. pylori eradication with quadruple therapy in areas with high clarithromycin resistance. Objective: To determine whether esomeprazole is more effective than other PPIs in the context of quadruple therapy for H. pylori eradication. Methods: We retrospectively identified 25- to 60-year-old subjects with a positive 13C-urea breath test and no prior laboratory or endoscopic test for H. pylori infection. Pharmacy dispensation data were retrieved. Results: A total of 7,896 subjects including 2,856 (36.2%) males, aged 40.4 ± 10.6 years, were identified. Of those, 78.1% received omeprazole, 20.1% received lansoprazole, 1.5% received esomeprazole, and 0.34% received pantoprazole together with antibiotics for H. pylori eradication. Esomeprazole was associated with a greater proportion of successful eradication (85.0 vs. 77.5%, esomeprazole vs. omeprazole, OR 1.64; 95% CI 0.99–2.72; p = 0.05). A nonsignificant trend favored esomeprazole over omeprazole among subjects receiving quadruple therapy (90.0 vs. 82.0%, respectively, OR 1.98; 95% CI 0.68–5.72; p = 0.16). Independent predictors of treatment success included older age and quadruple therapy. Conclusion: Esomeprazole is more beneficial than other PPIs for H. pylori eradication. Studies with larger subgroups are necessary to confirm our findings among subjects receiving quadruple therapy.

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EFFICACY OF RACM REGIMEN ON HELICOBACTER PYLORI ERADICATION IN PATIENTS OF CHRONIC GASTRITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.1.11 ◽

2016 ◽

pp. 88-93

Author(s):

Thi Hoai Thai ◽

Van Huy Tran

Keyword(s):

Helicobacter Pylori ◽

Side Effects ◽

Chronic Gastritis ◽

Eradication Rate ◽

Statistical Significance ◽

Rapid Urease Test ◽

Antibiotic Resistant ◽

Helicobacter Pylori Eradication ◽

Urease Test ◽

H Pylori

Background: H. pylori eradication still remains a challenge to clinicians, especially with the increasing antibiotic-resistant H. pylori. Concomitant therapy showed effective, even in some multiresistant population, but data in Vietnam is still very limited. The study ''Study of Helicobacter pylori eradication with RACM regimen in chronic gastritis patients at Da Nang Hospital from 1/4/2014 to 30/6/2015, is aimed at: (1) Evaluating the results of Helicobacter pylori eradication of Amoxicillin-Clarithromycin-Rabeprazole-Metronidazole therapy for 14 days.(2) Assessing some side effects of this regimen.Method: prospective, consisting of 83 patients examined and treated in Danang hospital from1/ 4/2014 to 30/6/2015, H.pylori was tested by rapid Urease test; H.pylori positive patients received RACM for 14 days. Results: H.pylori eradication rate was 83.1%. H. pylori eradication rates in different locations: antrum 63.8%, higher than corpus (17.4%), antrum and corpus (18.8%), with statistical significance at p<0.05. Common side effects was nausea (27.7%), diarrhea (19.3%). Abdominal pain, lightheadedness, dizziness, insomnia, headache account for low percentage: 8%; 6%; 3,6% and 2.4% respectively. Conclusion: The effect of 14 day RACM regimen for H. pylori eradication was 83.1%, common side effects are nausea (27.7%), diarrhea (19.3%). Key words: chronic gastritis;H. pylori; eradication of H. pylori(ITT); RACM regimen.

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Faculty Opinions recommendation of Randomised clinical trial: high-dose vs. standard-dose proton pump inhibitors for the prevention of recurrent haemorrhage after combined endoscopic haemostasis of bleeding peptic ulcers.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.714247817.789652845 ◽

2012 ◽

Author(s):

Ian Beales

Keyword(s):

Clinical Trial ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Standard Dose ◽

Randomised Clinical Trial ◽

High Dose ◽

Peptic Ulcers ◽

Endoscopic Haemostasis ◽

Bleeding Peptic Ulcers ◽

Recurrent Haemorrhage

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Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.262.itl ◽

2017 ◽

Vol 26 (2) ◽

pp. 129-137 ◽

Cited By ~ 7

Author(s):

Agostino Di Ciaula ◽

Giuseppe Scaccianoce ◽

Marino Venerito ◽

Angelo Zullo ◽

Leonilde Bonfrate ◽

...

Keyword(s):

Helicobacter Pylori ◽

Breath Test ◽

Eradication Rate ◽

Real Life ◽

Sequential Therapy ◽

Urea Breath Test ◽

Southern Europe ◽

Clarithromycin Resistance ◽

Asymptomatic Patients ◽

H Pylori

Background & Aims: H. pylori eradication is strongly affected by various factors, including the ongoing antibiotic resistance. We describe a “real life” scenario in patients managed for H. pylori-related conditions, living in a southern Italian region (Apulia), an area with clarithromycin resistance >15%.Methods: 2,224 subjects were studied in two tertiary referral centers in Apulia. Analyses included: reason for referral, H. pylori infection rates (13C-urea breath test – UBT or upper endoscopy), and eradication rates following distinct regimens previously prescribed or prospectively prescribed (such as the bismuth-based quadruple therapy Pylera®, recently marketed in Italy).Results. Over 80% of the patients were referred by family physicians (60% naïve subjects). The overall infection rate was 32.5% and it was similar in asymptomatic patients (31.1%) or with H. pylori-related symptoms/clinical conditions (34.3%). In the 987 H. pylori+ve patients receiving therapy, the overall eradication rate was 80.2% (ITT). Observed eradication rate varied greatly across different regimens: 57.1% (2nd line levofloxacin), 59.6% (unconventional), 70.7% (7-day triple), 73.2% (7-day undefined), 89% (10-day sequential) and 96.9% (ITT, 10 day Pylera®, 1st to 5th line regimens given to 227 patients).Conclusions. A heterogeneous “real life” scenario in Southern Europe shows that H. pylori+ve patients are put at risk of poor outcomes and points to the need of a susceptibility-based therapy according to guidelines and local microbial resistance. In the present setting (i.e. high clarithromycin resistance), despite the high observed eradication rate, sequential therapy should not be recommended (absent in guidelines, unneeded antibiotic). Bismuth-based quadruple treatment (1st, 2nd or subsequent lines) yields the highest eradication rates.Abbreviations: ALT: Altamura; BA: Bari; EGDS: esophagogastroduodenoscopy; GERD: gastro-esophageal reflux disease; H. pylori: Helicobacter pylori; ITT: intention-to-treat; PP: per-protocol; PPI: proton pump inhibitor; UBT: urea breath test.

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