Pooled analysis of <i>Helicobacter pylori</i> eradication regimes in Asia

Wang, Wei Hong; Wong, Benjamin C.Y.; Lam, Shiu Kum

doi:10.1046/j.1440-1746.2000.02253.x

Cited by 11 publications

(4 citation statements)

References 54 publications

(63 reference statements)

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“…Proton pump inhibitor‐based triple therapies are the mainstay of H. pylori eradication. Various meta‐analyses and clinical studies from different geographic areas have proven the efficacy of these treatments 42 . Most available data support the use of 1‐week proton pump inhibitor‐based triple therapy as first‐line treatment (Figure 1).…”

Section: Selection and Role Of Proton Pump Inhibitorsmentioning

confidence: 99%

Treatment of Helicobacter pylori infection and factors influencing eradication

Qasim

O’Moráin

2002

Aliment Pharmacol Ther

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Currently available Helicobacter pylori eradication therapies are considered very effective and safe. The most recent eradication guidelines proposed in the Maastricht 2‐2000 Consensus Report recommend the use of proton pump inhibitors (standard b.d.) along with clarithromycin (500 mg b.d.) and amoxycillin (1000 mg b.d.) or metronidazole (500 mg b.d.) for a minimum of 7 days. The combination of amoxycillin and clarithromycin is preferred because it may favour best results with a second‐line proton pump inhibitor quadruple therapy. The recommended second‐line therapy includes a combination of a proton pump inhibitor (standard b.d.) with bismuth salt (subsalicylate/subcitrate 120 mg q.d.s.), metronidazole (500 mg t.d.s.), and tetracycline (500 mg q.d.s.) for a minimum of 7 days. Extended proton pump inhibitor‐based triple therapy can be used if bismuth is not available. Specialists should manage subsequent failures. Based on direct and indirect evidence from well‐designed studies and clinical experience, eradication is recommended in gastric and duodenal ulcers, MALToma, atrophic gastritis, postgastric cancer resection, and in first‐degree relatives of gastric cancer patients. The most common reason for treatment failure is poor compliance with eradication guidelines. Antibiotic resistance may be a significant factor in certain geographical areas. Proton pump inhibitors are an integral part of the eradication regimens as proved by meta‐analyses of clinical trials. Novel agents used in secondary failure are few and depend on the use of new antibiotics. The role of H. pylori‐specific antibiotics, probiotics, and vaccines is not established as yet. Widespread acceptance of the eradication guidelines should be regarded as the single most important factor in eradication success.

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Section: Selection and Role Of Proton Pump Inhibitorsmentioning

confidence: 99%

Treatment of Helicobacter pylori infection and factors influencing eradication

Qasim

O’Moráin

2002

Aliment Pharmacol Ther

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“…Our results with a PPI, amoxycillin and clarithromycin regimen used in optimum dosages and duration are comparable to the results of a dual‐therapy regimen from one center in North India, 7 and is lower than that reported from two other North India centers, 8,9 as well as from a center in South India 19 . It was also lower than the pooled eradication rates of triple‐therapy regimens reported from Asia 20 …”

Section: Discussionmentioning

confidence: 68%

“…19 It was also lower than the pooled eradication rates of triple-therapy regimens reported from Asia. 20 Among the various factors influencing outcome in triple-therapy regimens, dosage of clarithromycin and duration of treatment are important. Increasing the dosage of clarithromycin from 500 mg/day to 1 g/day improves eradication frequency, but the cost of the regimen also increases steeply, imposing limitations in acceptability of the regimen when higher dosages are used.…”

Section: Discussionmentioning

confidence: 99%

Anti‐Helicobacter pylori therapy in India: Differences in eradication efficiency associated with particular alleles of vacuolating cytotoxin (vacA) gene

Chaudhuri¹,

Chowdhury²,

Datta³

et al. 2003

J of Gastro and Hepatol

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Background and Aims: The efficiency of Helicobacter pylori eradication varies geographically, as do many parameters that might affect therapeutic efficiency, including bacterial genotype. The aim of the present study was to determine the efficiency of H. pylori eradication using a 10‐day proton pump inhibitor‐based triple‐therapy regimen (omeprazole, clarithromycin and amoxycillin) in an eastern Indian patient population, and to find out the relationship, if any, of the success or failure of the therapy to known features of bacterial genotype. Methods Helicobacter pylori infections were analyzed in 66 duodenal ulcer patients by upper gastrointestinal endoscopy, rapid urease tests, histology and culture. The cytotoxin‐associated gene (cagA) and vacuolating cytotoxin (vacA) gene status of cultured strains were studied by polymerase chain reaction. Treatment was given for 10 days and endoscopy was repeated at 4 and 12 weeks post therapy to monitor ulcer healing and H. pylori eradication. Results: Ulcer healing was observed in 60 patients (96.77%). Helicobacter pylori was eradicated in 41 (62.12% intention to treat, 66.13% per protocol) of the 66 duodenal ulcer patients, but not in the other 25. The bacteria from 47 patients were genotyped. The only significant disease‐associated difference in patterns observed was that the vacA m1 allele was represented more disproportionately among patients with eradication failures (68%) than in those with successful eradication (39%) (P < 0.05) No significant association of vacAs1 (signal sequence allele) or cag pathogenicity island status with persistence was detected. Conclusions: This study highlights the public health need for cheaper, more cost‐effective anti‐H. pylori therapies for developing countries, and suggests that subtle features of bacterial genotype can influence therapeutic efficiency. The possibility that particular vacA mid region alleles affect persistence, perhaps through toxin action on particular gastric cell types, merits further study.

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“…All currently available proton pump inhibitors (PPIs) (esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole) appear to be equally effective when given with CA or CM. The overall success rate reported in clinical trials ranges from 59% to 100% (1,2,(19)(20)(21)(22)(23)(24)(25). Most studies evaluated a seven-day treatment duration.…”

Section: Characteristics Of Proton Pump Inhibitor-based Triple Therapiesmentioning

confidence: 99%