Rabeprazole‐based therapies in Helicobacter pylori eradication

Abstract

SUMMARYAim: To perform a systematic review of the efficacy of rabeprazole-based therapies in Helicobacter pylori eradication, and to conduct a meta-analysis comparing the efficacy of rabeprazole and other proton pump inhibitors when co-prescribed with antibiotics. Methods: Studies evaluating rabeprazole plus antibiotics were considered. Only randomized trials comparing rabeprazole and other proton pump inhibitors with antibiotics, and differing only in the proton pump inhibitor, were included in the meta-analysis. Electronic and manual bibliographic searches were conducted. The percentage (weighted mean) of successful eradication was calculated. Meta-analysis was performed by combining the odds ratios (OR) of the individual studies. Results: The eradication rates were as follows: 14-day rabeprazole-amoxicillin, 73%; rabeprazole-amoxicillin-clarithromycin for 3, 5, 7 and 10 days, 44%, 72%, 78% and 75%, respectively; low-dose rabeprazole (20 mg ⁄ day), amoxicillin and clarithromycin for 7 days, 81%; high-dose rabeprazole (40 mg ⁄ day), amoxicillin and clarithromycin for 7 days, 75%; 7-day rabeprazole-clarithromycin-nitroimidazole, 85%. Twelve comparative studies were included in the metaanalysis. The eradication rate with rabeprazole plus antibiotics was 79%; it was 77% with other proton pump inhibitors (OR ¼ 1.15; 95% confidence interval, 0.93-1.42). Sub-analysis comparing rabeprazole at low doses (10 mg

Potent Gastric Acid Inhibition in Helicobacter pylori Eradication

“…For instance, the combination rabeprazole-amoxycillin-clarithromycin given during 7-14 days is able to eradicate the infection in 75-98% of cases, [112] and the eradication success rate with the combination rabeprazole-clarithromycin-nitroimidazole is 85% -success levels that are similar to those previously reported for other PPIs. [2,56,79 -81] Furthermore, a meta-analysis of the comparative studies [112] demonstrates that rabeprazole is equivalent to other PPIs when given together with two antibiotics, as shown in figure 3. From the results of the studies included in that metaanalysis, [113][114][115][116][117][118][119][120][121][122][123] with 1076 patients treated with rabeprazole and 1150 treated with other PPIs, mean eradication efficacies of 79% and 77%, respectively, were calculated.…”

“…In this case, the systematic review of the available literature shows that the eradication rate with rabeprazole and amoxycillin (dual therapy) for 14 days is rather low, about 70%. [112] However, triple therapies (i.e., rabeprazole together with two antibiotics) achieve therapeutic success more frequently. For instance, the combination rabeprazole-amoxycillin-clarithromycin given during 7-14 days is able to eradicate the infection in 75-98% of cases, [112] and the eradication success rate with the combination rabeprazole-clarithromycin-nitroimidazole is 85% -success levels that are similar to those previously reported for other PPIs.…”

“…[112] However, triple therapies (i.e., rabeprazole together with two antibiotics) achieve therapeutic success more frequently. For instance, the combination rabeprazole-amoxycillin-clarithromycin given during 7-14 days is able to eradicate the infection in 75-98% of cases, [112] and the eradication success rate with the combination rabeprazole-clarithromycin-nitroimidazole is 85% -success levels that are similar to those previously reported for other PPIs. [2,56,79 -81] Furthermore, a meta-analysis of the comparative studies [112] demonstrates that rabeprazole is equivalent to other PPIs when given together with two antibiotics, as shown in figure 3.…”

“…One of the main isoenzymes involved in PPI metabolism is CYP2C19, and a number of mutations have been described in this enzyme that may be responsible for genetic polymorphisms and for consequent modifications in the metabolism and in the pharmacokinetic profiles of the PPIs. [112] It was initially demonstrated that the H. pylori eradication rate achieved with other PPIs, such as omeprazole or lansoprazole, depended on the patient's CYP2C19 genotype. [124,125] It has been later suggested that the metabolism of rabeprazole is less dependent on that genotype, as this last PPI is Potent Gastric Acid Inhibition in H. pylori Eradication 89 Fig.…”

Gastric Pyogenic Granuloma Detected due to Abdominal Symptoms and Treated with Endoscopic Resection

“…We believe that a duration of two weeks after eradication was adequate to evaluate the effects of eradication because, in the literature, the symptoms caused by peptic ulcers immediately disappear within one week after H. pylori eradication (14,15). The cause of the pain originating from the gastric pyogenic granuloma was obscure, as we were unable to find any reports of epigastric pain in patients with pyogenic granulomas in the gastrointestinal tract.…”