Second-line bismuth-containing quadruple therapy for <i>Helicobacter pylori</i> eradication and impact of diabetes

Kim, Sung Eun; Park, Moo In; Park, Seun Ja; Moon, Won; Kim, Jae Hyun; Jung, Kyoungwon; Kim, Hae Koo; Lee, Young Dal

doi:10.3748/wjg.v23.i6.1059

Cited by 14 publications

(10 citation statements)

References 38 publications

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“…A previous study reported that diabetes mellitus may be a factor in reducing the eradication rate in second-line BQT [28]. Additionally, female sex [29][30][31][32][33] and the presence of a gastroduodenal ulcer [34][35][36] are associated with the failure of H. pylori eradication therapy.…”

Section: Discussionmentioning

confidence: 99%

Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

Lee

Shin

et al. 2020

Korean J Intern Med

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Background/Aims: The negative effects on the eradication success of Helicobacter pylori infection after previous exposure to macrolides, including clarithromycin on clarithromycin-based first-line therapy have been demonstrated. However, whether this is true for metronidazole-based second-line quadruple therapy remains unclear. We investigated the relationship between past administration of metronidazole and the failure of metronidazole-based second-line quadruple therapy in patients with H. pylori infection. Methods: Patients over 20 years of age who were diagnosed with H. pylori infection between January 1998 and March 2016 were enrolled in this study. The relationship between the clinical parameters and the results of a C13-urea breath test after metronidazole-based second-line quadruple therapy was analyzed in patients for whom clarithromycin-based triple therapy failed to eradicate H. pylori. Results: The H. pylori eradication failure rate was significantly higher in patients with a history of metronidazole use than in patients without a history of metronidazole use (p = 0.011). Multivariable analysis showed that the odds ratio of previous metronidazole use for eradication failure was 3.468 (95% confidence interval, 1.391 to 8.649; p = 0.008). In the subgroup analysis of patients with a history of metronidazole use, the duration of metronidazole use and interval between its use and eradication therapy did not significantly affect H. pylori eradication failure. Conclusions: Previous exposure to metronidazole was a significant risk factor for treatment failure of metronidazole-based second-line quadruple therapy; therefore, this should be considered when establishing a treatment strategy for patients with H. pylori infection.

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Section: Discussionmentioning

confidence: 99%

Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

Lee

Shin

et al. 2020

Korean J Intern Med

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“…[8,9,12,13] However, Korea is classified as a region with high clarithromycin (>15%) and metronidazole resistance (>30%). [9,16] Data on the trends over time have shown a constant acceptable eradication success rate for bismuth-containing quadruple therapy as a 2nd-line regimen; [24,26,27] however, there is a paucity of data on its use as a 1st-line regimen in Korea. [28] Moreover, there is no definite 2nd-line or 3rd-line rescue regimen for patients who do not respond to the above therapies.…”

Section: Discussionmentioning

confidence: 99%

Modified quadruple therapy versus bismuth-containing quadruple therapy in first-line treatment of Helicobacter pylori infection in Korea; rationale and design of an open-label, multicenter, randomized controlled trial

Lim¹,

Bang²,

Shin³

et al. 2018

Medicine

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Background:Clarithromycin-containing triple regimen for eradication of Helicobacter pylori is no longer acceptable in Korea due to high clarithromycin resistance. Concomitant therapy or bismuth-containing quadruple therapy is recommended as an alternative regimen. A recent study in Korea has shown that modified quadruple therapy has comparable efficacy and safety to concomitant therapy as a first-line regimen. However, there has been no comparative study of modified quadruple therapy with bismuth-containing quadruple therapy. The aim of this study is to compare the efficacy and safety of modified quadruple therapy with those of bismuth-containing quadruple therapy as a first-line regimen and to present the phenotypic and genotypic antibiotic resistance profile of H pylori.Methods:This study is an open-label, multicenter, randomized controlled trial. We are recruiting subjects endoscopically diagnosed with H pylori infection from 2 hospitals in Korea. Subjects will be randomly allocated either to modified quadruple therapy (proton-pump inhibitor bid, amoxicillin 1 g bid, metronidazole 500 mg tid, bismuth subcitrate 300 mg qid daily) or bismuth-containing quadruple therapy (proton-pump inhibitor bid, tetracycline 500 mg qid, metronidazole 500 mg tid, bismuth subcitrate 300 mg qid daily) for 14 days. The rate of eradication success and adverse events will be checked at least 4 weeks after the treatment. Antibiotic resistance will be established using both a bacterial culture with agar dilutions and DNA sequencing of the clarithromycin resistance point mutations in the 23S rRNA gene of H pylori.Conclusion:The results of this study will provide solid evidence for determining the optimal treatment regimen for first-line H pylori eradication in Korea.

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“…In all studies included, 11 prospective studies compared the H. pylori eradication rate in diabetes and non‐diabetes 29‐39 . Eleven retrospective studies compared the proportion of diabetes and other clinic factors (age, gender, smoking, drinking, overweight, peptic ulcer disease, blood pressure, and history of NSAIDS) in groups failed and succeed in H. pylori eradication 40‐50 . Four studies further compared the level of HbA1c in diabetics failed and succeed in H. pylori eradication 30,35,37,49 .…”

Section: Resultsmentioning

confidence: 99%

The efficacy of Helicobacter pylori eradication in diabetics and its effect on glycemic control: A systematic review and meta‐analysis

et al. 2021

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Background and Aims Previous studies have revealed the association between Helicobacter pylori (H. pylori) and diabetes mellitus, but conflicts still exist. The present study tried to investigate the underlying link between these two diseases by making comprehensive analyses of the impact of diabetes on H. pylori eradication and the influence of H. pylori eradication on diabetes. Methods We systematically searched relevant studies from PubMed, Cochrane Library, Web of Science, and Embase updated to April 23, 2020. Studies examining the association between H. pylori eradication and diabetes were included. Pooled odds ratio (OR) and weighted mean differences (WMD) were calculated for different results. Results Among the 2125 retrieved studies, 36 studies were included. Patients with type 2 diabetes mellitus (T2DM) have higher risk of H. pylori eradication failure than the non‐diabetic one (OR = 2.59, 95% CI 1.82–3.70). Body mass index (BMI) was identified as a major factor affecting the efficacy of H. pylori eradication in diabetics, and better glycemic control was also found in eradication succeed patients (WMD: 0.51, 95% CI 0.20–0.81). Moreover, after eradication of H. pylori, improvement of HbA1c was proved (WMD = −0.33, 95% CI −0.65 to −0.02) in T2DM. Conclusion A higher risk of H. pylori eradication failure in T2DM was confirmed, and it was associated with BMI and glycemic control. Moreover, we also provided evidence that H. pylori eradication could improve glycemic control in patients with T2DM, which indirectly reflect the interaction between H. pylori and the diabetes.

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Second-line bismuth-containing quadruple therapy for Helicobacter pylori eradication and impact of diabetes

Cited by 14 publications

References 38 publications

Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection

Modified quadruple therapy versus bismuth-containing quadruple therapy in first-line treatment of Helicobacter pylori infection in Korea; rationale and design of an open-label, multicenter, randomized controlled trial

The efficacy of Helicobacter pylori eradication in diabetics and its effect on glycemic control: A systematic review and meta‐analysis

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