<i>Helicobacter pylori</i> eradication rates of concomitant and sequential therapies in Korea

Kim, Seung Young; Lee, Sang Woo; Choe, Jung Wan; Jung, Sung Woo; Hyun, Jong Jin; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon

doi:10.1111/hel.12441

Cited by 20 publications

(20 citation statements)

References 36 publications

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“…In this study, the overall eradication rates of concomitant therapy were 86.2% and 90.2% in the ITT and PP analyses, respectively, which were similar to those in previous Korean studies . In addition, the frequency of significant adverse effects was not different between the concomitant therapy and tailored therapy groups.…”

Section: Discussionsupporting

confidence: 88%

“…In addition, concomitant therapy failed to show superiority to tailored therapy (PMA regimen) in point mutation‐positive subjects. These results were discordant with a previous Korean study that reported effective eradication rates with concomitant therapy (>90%), even in patients with point mutations …”

Section: Discussionsupporting

confidence: 69%

“…Assuming a concomitant therapy eradication rate of 85%, the minimum number of patients required in each group to obtain statistical power with an α‐error of .05, a β‐error of .20, and equivalence margin of −10% was calculated to be at least 165 subjects in each group for this noninferiority trial. Considering a withdrawal rate of 15%, at least 195 subjects in each group were required.…”

Section: Methodsmentioning

confidence: 99%

“…Among the various new regimens, concomitant therapy, which involves the administration of a PPI and three antibiotics (amoxicillin, clarithromycin, and metronidazole or tinidazole) simultaneously for 10‐14 days, showed a highly effective eradication rate of 80%‐86% in intention‐to‐treat (ITT) analyses in several studies; thus, concomitant therapy may be an alternative empirical first‐line regimen for high clarithromycin‐resistant regions. However, concomitant therapy has several limitations, such as the possibility of a high prevalence of secondary resistance and suboptimal efficacy in cases with dual clarithromycin/metronidazole resistance …”

Section: Introductionmentioning

confidence: 99%

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Helicobacter pylori eradication rates with concomitant and tailored therapy based on 23S rRNA point mutation: A multicenter randomized controlled trial

Ong

Kim

et al. 2019

Helicobacter

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Background:We evaluated the efficacy of tailored therapy based on point mutation presence identified with the dual-priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) method compared with concomitant therapy. Materials and methods:Subjects were randomly assigned concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg, metronidazole 500 mg, and lansoprazole 30 mg twice/day for 14 days) or tailored therapy (amoxicillin 1 g, clarithromycin 500 mg, and lansoprazole 30 mg twice/day for 14 days in point mutation-negative subjects; and amoxicillin 1 g, metronidazole 500 mg, and lansoprazole 30 mg twice/ day for 14 days in point mutation-positive subjects). Results:A total of 397 and 352 subjects were included in the intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. Point mutations were identified in 25.9% of the subjects. The overall eradication rate was not significantly different between the groups by ITT (86.2% vs 81.6%, P = .132) and PP analyses (90.2% vs 86.5%, P = .179). There was no significant difference in the eradication rates between the groups in both the point mutation-negative subjects (91.7% vs 87.3%, P = .154) and the point mutation-positive subjects (71.2% vs 64.7%, P = .312). The eradication rates were significantly lower in the point mutation-positive subjects than in the point mutation-negative subjects in both the concomitant and tailored therapy groups.Conclusions: Tailored therapy based on point mutation presence identified with the DPO-based multiplex PCR method was as effective as concomitant therapy. The eradication rates of both therapy regimens were suboptimal in point mutation-positive subjects. K E Y W O R D Sconcomitant therapy, eradication, point mutation, tailored therapy

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Helicobacter pylori eradication rates with concomitant and tailored therapy based on 23S rRNA point mutation: A multicenter randomized controlled trial

Ong

Kim

et al. 2019

Helicobacter

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“…2 Thus, in order to overcome the limitations of the existing standard triple therapy, antimicrobial therapy has been used in combination with various regimens such as bismuth-containing quadruple, sequential, and concomitant therapy. 25 Interestingly, the approach to treat H pylori infection is quite different from the treatment protocols for other infectious diseases. 26 For instance, H pylori therapy should be based on local and individual antibiotic resistance patterns, if possible.…”

Section: Southmentioning

confidence: 99%

Efficacy of tailored therapy for Helicobacter pylori eradication based on clarithromycin resistance and survey of previous antibiotic exposure: A single‐center prospective pilot study

et al. 2019

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Background As the prevalence of antibiotic resistance is increasing, the effectiveness of traditional Helicobacter pylori (H pylori) therapies is gradually declining. We aimed to evaluate the efficacy of tailored therapy (dual priming oligonucleotide [DPO]‐based multiplex PCR) and previous antibiotic exposure survey predicting for antibiotic resistance. Materials and Methods Patients with H pylori infection who did not receive previous treatment were enrolled. The patients were divided into four groups (no resistance [NR] group, clarithromycin resistance [CLA‐R] group, metronidazole‐resistant [MET‐R] group, and CLA‐ and MET‐resistant [Dual‐R] group) based on the results of dual priming oligonucleotide (DPO) polymerase chain reaction (PCR) and previous antibiotic exposure survey, and they were treated with tailored therapy based on antibiotic susceptibility. Results Consecutive patients were distributed in the NR (n = 36, 70.6%), CLA‐R (n = 9, 17.6%), and suspected MET‐R (n = 6, 11.8%) group. The overall intention‐to‐treat/per‐protocol eradication rate (ITT/PP) was 92.2%/94.0%. In the subgroup analysis, the ITT and PP of the NR, CLA‐R, and MET‐R groups were 94.4%/94.4%, 77.8%/87.5%, and 100.0%/100.0%, respectively. Total of 31 patients in all subgroups were evaluated for antibiotic resistance; five (16.1%), two (6.5%), and three (9.7%) participants showed CLA, MET, and dual resistance in culture‐based susceptibility test. Compared with culture‐based MIC test, the accuracy of DPO‐based multiplex PCR in determining CLA resistance was 90.3%, while the accuracy of survey in determining MET resistance was only 77.4%. Conclusion A tailored therapy based on DPO‐PCR and history of previous antibiotic use is useful in clinical practice and well correlated with culture‐based susceptibility test.

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Treatment of non-erosive reflux disease and dynamics of the esophageal microbiome: a prospective multicenter study

Park

Seo

Kim

et al. 2020

Sci Rep

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Non-erosive reflux disease (NERD) pathogenesis has not been thoroughly evaluated. Here, we assessed the response of patients with NERD to proton pump inhibitor (PPI) therapy; changes in the microbiome and biologic marker expression in the esophageal mucosa were also evaluated. Patients with NERD (n = 55) received esomeprazole (20 mg) for eight weeks. The treatment response was evaluated at baseline, week four, and week eight. Esophageal mucosal markers and oropharyngeal and esophageal microbiomes were analyzed in patients who underwent upper gastrointestinal endoscopy at screening (n = 18). Complete and partial response rates at week eight were 60.0% and 32.7% for heartburn, and 61.8% and 29.1% for regurgitation, respectively. The expressions of several inflammatory cytokines, including IL-6, IL-8, and NF-κB, were decreased at week eight. Streptococcus, Haemophilus, Prevotella, Veillonella, Neisseria, and Granulicatella were prevalent regardless of the time-point (baseline vs. week eight) and organ (oropharynx vs. esophagus). The overall composition of oropharyngeal and esophageal microbiomes showed significant difference (P = 0.004), which disappeared after PPI therapy. In conclusion, half-dose PPI therapy for eight weeks could effectively control NERD symptoms. The expression of several inflammatory cytokines was reduced in the esophagus, and oropharyngeal and esophageal microbiomes in patients with NERD showed significant difference. However, the microbial compositions in the oropharynx and esophagus were not affected by PPI therapy in this study. Impact of PPI on the microbiome in patients with NERD should be more investigated in future studies.

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Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea

Abstract: Concomitant therapy was superior to sequential therapy as the first-line treatment for H. pylori eradication, especially in clarithromycin-resistant strains in Korea.

Cited by 20 publications

References 36 publications

Helicobacter pylori eradication rates with concomitant and tailored therapy based on 23S rRNA point mutation: A multicenter randomized controlled trial

Helicobacter pylori eradication rates with concomitant and tailored therapy based on 23S rRNA point mutation: A multicenter randomized controlled trial

Efficacy of tailored therapy for Helicobacter pylori eradication based on clarithromycin resistance and survey of previous antibiotic exposure: A single‐center prospective pilot study

Treatment of non-erosive reflux disease and dynamics of the esophageal microbiome: a prospective multicenter study

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