Investigating the Efficacy of Triple Drug Therapy and Sequential Drug Therapy in the Eradication of Helicobacter Pylori with Respect to Antigen Stool test: A Pilot Study

Abstract

Background Helicobacter pylori is one of the most prevalent infectious disease worldwide. The treatment regimens involve mainly two therapies: Standard Triple drug therapy and Sequential drug therapy. Several studies have shown that the sequential therapy has higher eradication rates of H. pylori than the standard triple drug therapy and since proper study on sequential drug therapy and standard triple drug therapy is still lacking in Nepal, this study is attempted to compare efficacy of Sequential Drug Therapy in the eradication of H. pylori in gastritis with respect to the Standard triple drug therapy. 
 Objective To investigate the efficacy of Triple Drug Therapy and Sequential Drug Therapy in the eradication of Helicobacter pylori with respect to Antigen Stool test. 
 Method This study was the prospective study conducted in 62 patients attending the Department of Gastroenterology, Dhulikhel Hospital, meeting the inclusion criteria who were confirmed as H. pylori positive by histopathology and stool antigen test. Patients were randomized into two groups. One group prescribed with Standard triple drug regimen and another group with Sequential drug regimen. Eradication of H. pylori infection was confirmed by repeating the stool antigen test at least five weeks after the completion of the regimen. 
 Result Among the 62 participants included in this study, 54.5% of them were males. Among the study population, the eradication achieved by standard triple drug therapy was 87.8% and 89.6% with Sequential drug therapy. Higher numbers (82.3%) of patients were compliant to the prescribed medication. Forgetfulness was the main reason for missing the dose (91%) of the non-compliant patients. 
 Conclusion The study revealed an equal efficacy of both Standard Triple drug regimen and Sequential drug regimen in the eradication of H. pylori infection. Further, Stool antigen test can be preferred as a non-invasive test, for diagnosis of H. pylori infection, monitoring the response to treatment and in epidemiological studies.

Outcome of 14-Day Sequential and Levofloxacin-Based Triple Regimen as the First-Line Therapy in Patients with Helicobacter pylori Infection: A Prospective Comparative Study from Southern Central Nepal

“…21 However, another prospective study in similar setting by Shrestha et al reported relatively better eradication rate (89%) with sequential therapy. 22 In a recent randomized controlled trial from India, the eradication rate with sequential therapy was found to be 92.9%, which is much higher than the current study. 23 These differences in the eradication rates of sequential therapy can be explained on the basis of different population groups with possibly varying resistance rates to the antibiotics.…”

Sequential versus Standard Triple Therapy for First-Line Helicobacter pylori Eradication: An Update

“…Figures 2 and 3 summarize the risk of bias in the findings of the included studies. Risk of bias summary: review authors' judgements about each risk of bias item (low risk, unclear risk and high risk) for each included study [31,[35][36][37][38][39][40][42][43][44][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][93][94][95][96][97][98][99][100][101][102][103][104].…”

“…Over half (n = 38) of the included studies were conducted in Asia, over one-third (n = 22) were conducted in Europe and four took place each in South America and Africa (Figure 5). Thirty-eight of the studies [46][47][48][49][50][51][52][54][55][56][57][58][59][60][61][62][63]65,67,68,[71][72][73][81][82][83][84][85][86]93,95,100,104] were performed in Asia (mainly China and Korea but one in Japan, one in Singapore and one in India). Twenty-two were conducted in Europe [31,[35][36][37][38][39][40][41][42][43][44]66,[77][78][79]…”