Helicobacter pylori eradication and peptic ulcer healing: the impact of deleting the proton pump inhibitor and using a once‐daily treatment

Abstract

SUMMARYAim: To compare cheaper and simpler once-daily regimens, with and without a proton pump inhibitor, with standard, twice-daily, triple therapy. Methods: A randomized, placebo-controlled, treatment trial in Vietnam allocated 296 Helicobacter pyloriinfected patients with peptic ulcer of ‡ 5 mm to one of three regimens: (i) twice-daily: lansoprazole 30 mg, clarithromycin 250 mg and tinidazole 500 mg; (ii) once-daily: lansoprazole 60 mg, clarithromycin 500 mg and tinidazole 1000 mg; (iii) once-daily: placebo, clarithromycin 500 mg and tinidazole 1000 mg. H. pylori status was assessed by culture and immunoblot, ulcer healing by endoscopy and side-effects by structured questionnaires.Results: Per protocol eradication (N ¼ 256) was higher with standard therapy (87%) than with once-daily therapy (72%), and both were better than once-daily therapy without proton pump inhibitor (39%). Per protocol ulcer healing after standard therapy (83%) was not significantly better than that after once-daily therapy (73%), but better than that after therapy without proton pump inhibitor (65%). Side-effects were reported at similar rates in all groups. Conclusions: Proton pump inhibitor was needed for optimal eradication and ulcer healing. Twice-daily administration showed improved success rates when compared with once-daily therapies. Peptic ulcer healing was achieved even in patients treated with antibiotics only, confirming the central role of H. pylori in the pathophysiology of peptic ulcer disease.

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

“…These results were later confirmed by another RCT, where the combination of clarithromycin and tinidazole was evaluated with or without lansoprazole [147]. …”

The importance of the level of metronidazole resistance for the success of Helicobacter pylori eradication

“…In a clinical study on eradication treatment of H. pylori infection and peptic ulcer disease in Vietnam, 23 296 patients were randomized to either group LCT × 2: lansoprazole 30 mg twice daily (b.i.d), clarithromycin 250 mg b.i.d., tinidazole 500 mg b.i.d; group LCT × 1: lansoprazole 60 mg once‐daily (q.d. ), clarithromycin 500 mg q.d., tinidazole 1000 mg q.d.…”

“…Culture was performed at the Department of Microbiology, Karolinska Hospital in Stockholm, Sweden as has been described earlier 23 . Helicobacter pylori growth was identified as Gram‐negative curved rods producing catalase, urease and oxidase.…”

Treatment of H. pylori Infection: A Review

“…Several mechanisms have been called to account for this synergistic effect, such as the inhibition of bacterial urease, or the improvement of antibiotic bioavailability, achieved by increasing gastric pH [24]. The higher eradication rate of therapies including a PPI compared to eradication treatments based only on antimicrobial drugs have confirmed these data [25][26]. Also, a recent metanalysis showed that therapies based on a double PPI doses reached a significantly higher eradication rates than regimens based on a single daily dose of PPI [27].…”