Combination of Bismuth and Standard Triple Therapy Eradicates Helicobacter pylori Infection in More than 90% of Patients

McNicholl, Adrián G.; Bordin, D.S.; Lucendo, Alfredo J.; Fadeenko, Galina; Fernández, Manuel; Voynovan, Irina; Zakharova, Natalia; Сарсенбаева, А. С.; Bujanda, Luís; Pérez-Aísa, Ángeles; Вологжанина, Л. Г.; Zaytsev, O V; Ильчишина, Т. А.; Coba, Cristóbal De la; Lasala, Jorge Pérez; Алексеенко, С. А.; Modolell, Inés; Molina–Infante, Javier; López, Rafael Ruíz-Zorrilla; Alonso-Galán, Horacio; Moreno, Nuria Fernandez; J, Hinojosa; Santaella, Inmaculada; Varela, Pilar; Gonzalez-Cordero, Pedro L.; Barrio, Jesús; Domínguez-Jiménez, José Luis; Núñez, Óscar; Alcedo, Javier; Nyssen, Olga P.; Caldas, María; Donday, María G.; Shvetz, Oleg; Mégraud, Françis; O’Moráin, Colm; Gisbert, Javier P.

doi:10.1016/j.cgh.2019.03.048

Cited by 65 publications

(56 citation statements)

References 34 publications

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“…Therefore, it is recommended by the latest Chinese guidelines for treating H pylori infection 6 . Recently, according to the data analysis from a large multi‐center European registry, 14‐day TPB therapy achieved good eradication rate (more than 90%) based on ITT analysis with an acceptable safety profile and level of adherence 13 . So, this regimen may be recommended more widely in future.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of 14‐day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first‐line Helicobacter pylori infection eradication: A randomized trial

et al. 2020

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Background Favorable outcomes in treating H pylori infection using “dual therapy (proton pump inhibitor and amoxicillin four times daily)” have attracted widespread attention. However, there are few reports, and the study results lack agreement. This study aimed to compare the eradication rate, safety, and compliance of naïve‐treatment patients with H pylori infection on “dual therapy” with those on “triple plus bismuth (TPB) therapy.” Methods This is a non‐inferior randomized controlled trial conducted on 760 patients with H pylori infection. The participants were randomly assigned to two eradication groups: dual therapy (esomeprazole 20 mg and amoxicillin 750 mg four times daily) and TPB therapy (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 220 mg twice daily) for 14 days. Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed about 8 weeks after eradication to evaluate outcome. Antibiotic resistance and CYP2C19 polymorphism were determined. Results Compared with TPB therapy, dual therapy had significantly higher eradication rates in intention‐to‐treat (87.1% vs 80.5%, rate difference 6.6%), modified intention‐to‐treat (90.9% vs 85.5%, 5.5%) and per‐protocol (92.4% vs 87.8%, 4.7%) analyses, respectively. Adverse reactions in dual therapy group were significantly lower than TPB therapy group (17.6% vs 25.5%, P = .008), and dual therapy group had better compliance (96.3% vs 92.3%, P = .019). Antibiotic resistance and poor compliance were also associated with treatment failure. Conclusions Dual therapy (esomeprazole and amoxicillin four times daily) was non‐inferior to, and even superior to TPB therapy as first‐line H pylori eradication.

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Section: Introductionmentioning

confidence: 99%

A comparative study of 14‐day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first‐line Helicobacter pylori infection eradication: A randomized trial

et al. 2020

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“…Finally, there was no “empirical” control group in the present study. Recently, McNicholl et al reported an interim analysis of the current dataset of the European Registry on H pylori Management (Hp‐EuReg), which demonstrated that empirical bismuth‐based quadruple therapy could eradicate H pylori infection in more than 90% of patients 45 . However, the eradication rates (ITT) varied among Spanish, Russian, and Ukrainian patients (ITT: 93.2%, 81.9%, and 70.1%, respectively; PP; 94.0%, 91.7%, and 90.0%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of bismuth‐based quadruple therapy for eradication of Helicobacter pylori infection based on previous antibiotic exposure: A large‐scale prospective, single‐center clinical trial in China

et al. 2020

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Objective This study aims to evaluate the efficacy and safety of three bismuth‐based quadruple regimens for eradication of Helicobacter pylori (H pylori) infection in a large number of H pylori‐positive patients with or without previous eradication therapy. Methods Consecutive adult patients with H pylori infection, regardless of previous eradication therapy, were eligible for the present study. Three bismuth‐based quadruple regimens were selected according to the past history of antibiotics use: (A) esomeprazole, amoxicillin, clarithromycin, and colloidal bismuth tartrate; (B) esomeprazole, amoxicillin, furazolidone, and colloidal bismuth tartrate; and (C) esomeprazole, doxycycline, furazolidone, and colloidal bismuth tartrate. All patients received a 14‐day course of treatment, and 13C/14C urea breath test was utilized at four weeks after the completion of treatment to determine the H pylori eradication. Then, the eradication rates were calculated in terms of intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Adverse events (AEs) were recorded during the treatment. Results Overall, 1,226 patients were recruited, and 331, 57, and 838 patients were allocated to receive regimens A, B, and C, respectively. The H pylori eradication rates were 84.0%, 82.5%, and 82.9% (ITT) and 94.6%, 92.2%, and 93.7% (PP), respectively, in regimens A, B, and C. However, there was no significant difference among these three regimens. The incidence of AEs was 4.6% for all patients during the study, that is, 3.3%, 10.5%, and 4.7% for regimens A, B, and C, respectively. All AEs were mild and recovered at the follow‐up visit. Conclusion All three bismuth‐based quadruple regimens based on the previous antibiotic use can achieve satisfactory eradication rates for H pylori infection and are safe.

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“…О наличии преимущества свидетельствуют результаты опубликованного в 2020 г. исследования, в котором эффективность эрадикационной терапии, включавшей ИПП, ВТД, амоксициллин, кларитромицин, в данном регионе составила 91,9% [28]. Сходные результаты, показывающие высокий уровень эрадикации H. pylori, превышающий 90%, при применении стандартной тройной терапии, усиленной препаратом висмута, показаны в ряде опубликованных ранее работ [29][30][31], а также при анализе данных общероссийской [18] и международной части регистра Hp-EuReg [32].…”

Section: ðèñ 4 ñõåìû ýðàäèêàöèîííîé òåðàïèè íàçíà÷åííûå â êà÷åñòâåunclassified

European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan

Абдулхаков

Bordin

Абдулхаков³

et al. 2020

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Background. As part of an observational multicenter prospective study European Registry on the management of Helicobacter pylori infection, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed. Materials and methods. The data of 437 patients included into the register by clinical sites in Kazan in 20132019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients. Results. The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%. Conclusion. The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesnt reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.

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Combination of Bismuth and Standard Triple Therapy Eradicates Helicobacter pylori Infection in More than 90% of Patients

Cited by 65 publications

References 34 publications

A comparative study of 14‐day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first‐line Helicobacter pylori infection eradication: A randomized trial

A comparative study of 14‐day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first‐line Helicobacter pylori infection eradication: A randomized trial

Efficacy of bismuth‐based quadruple therapy for eradication of Helicobacter pylori infection based on previous antibiotic exposure: A large‐scale prospective, single‐center clinical trial in China

European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan

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