Sequential therapy versus standard triple therapy for Helicobacter pylori eradication in children

Kutluk, Günsel; Tutar, Engin; Bayrak, Nevzat Aykut; Volkan, Burcu; Akyön, Yakut; Çelikel, Çiğdem; Ertem, Deniz

doi:10.1097/meg.0000000000000190

Cited by 24 publications

(36 citation statements)

References 40 publications

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“…Standard triple therapy remains the gold standard for eradicating H. pylori ; however, more recent studies have shown a constant decline in H. pylori eradication rates, to as low as 50% 12,23,24. This decline has been attributed to increased clarithromycin resistance and low medication compliance secondary to medication side effects 13,14.…”

Section: Discussionmentioning

confidence: 99%

“…Despite initial successes, there has been a constant decline in H. pylori eradication rates with standard triple therapy in both adult and pediatric populations, from 75 to 55% between 2009 and 2014 12. Although several mechanisms have been proposed, most of the studies agree that the main reasons for the declining efficacy are the increasing resistance to clarithromycin and poor medication compliance as a result of antibiotic-induced nausea, vomiting, and diarrhea 13–15.…”

Section: Introductionmentioning

confidence: 99%

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Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

Lau¹,

Ward²,

Chamberlain³

2016

IDR

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IntroductionHelicobacter pylori colonization is present in half of the world’s population and can lead to numerous gastrointestinal diseases if left untreated, including peptic ulcer disease and gastric cancer. Although concurrent triple therapy remains the recommended treatment regimen for H. pylori eradication, its success rate and efficacy have been declining. Recent studies have shown that the addition of probiotics can significantly increase eradication rates by up to 50%. This meta-analysis examines the impact of probiotic supplementation on the efficacy of standard triple therapy in eradicating H. pylori.MethodsA comprehensive literature search was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (time of inception to 2016) to identify all published randomized control trials (RCTs) assessing the use of probiotics in addition to triple therapy for the treatment of H. pylori. Searches were conducted using the keywords “probiotics”, “triple therapy”, and “Helicobacter pylori”. RCTs comparing the use of probiotics and standard triple therapy with standard triple therapy alone for any duration in patients of any age diagnosed with H. pylori infection were included. H. pylori eradication rates (detected using urea breath test or stool antigen) were analyzed as-per-protocol (APP) and intention-to-treat (ITT).ResultsA total of 30 RCTs involving 4,302 patients APP and 4,515 patients ITT were analyzed. The addition of probiotics significantly increased eradication rates by 12.2% (relative risk [RR] =1.122; 95% confidence interval [CI], 1.091–1.153; P<0.001) APP and 14.1% (RR =1.141; 95% CI, 1.106–1.175; P<0.001) ITT. Probiotics were beneficial among children and adults, as well as Asians and non-Asians. No significant difference was observed in efficacy between the various types of probiotics. The risk of diarrhea, nausea, vomiting, and epigastric pain was also reduced.ConclusionThe addition of probiotics is associated with improved H. pylori eradication rates in both children and adults, as well as Asians and non-Asians. Lactobacillus, Bifidobacterium, Saccharomyces, and mixtures of probiotics appear beneficial in H. pylori eradication. Furthermore, the reduction in antibiotic-associated side effects such as nausea, vomiting, diarrhea, and epigastric pain improves medication tolerance and patient compliance. Given the consequences associated with chronic H. pylori infection, the addition of probiotics to the concurrent triple therapy regimen should be considered in all patients with H. pylori infection. However, further studies are required to identify the optimal probiotic species and dose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

Lau¹,

Ward²,

Chamberlain³

2016

IDR

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“…[27][28][29] According to studies conducted in Italy, ITT analysis showed a high rate of eradication (98%), and complications occurred at 6%. 30 Several studies have reported higher eradication rates of H. pylori than standard triple therapy.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study ofHelicobacter pyloriEradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Jung

Kim

Chung

2017

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: Clarithromycin resistance is one of the main predictors of eradication treatment failures in Helicobacter pylori infections. The aim of this study was to investigate the ideal eradication rate of more than 90% of tailored therapies using a polymerase chain reaction (PCR)-based test for clarithromycin resistance in patients with peptic ulcer disease. In addition, we evaluated the possibility of sequential therapies for infections due to clarithromycin-resistant strains. Materials and Methods: We prospectively enrolled patients referred to the gastroenterology unit for the evaluation and management of peptic ulcer from January 2012 to January 2014. Histology, a rapid urease test, and a dual-priming oligonucleotide-based multiplex (DPO)-PCR test were performed on gastric biopsy specimens. In the absence of 23S rRNA point mutations in H. pylori, the patients were treated with standard triple therapy, while in the presence of 23S rRNA point mutations, they were treated with sequential therapies. Results: A total of 93 patients had peptic ulcer disease that was associated with H. pylori infections. These patients received eradication therapies, and 78 patients completed the therapies. The total eradication rate was 91% per protocol analysis, whereas it was 78.3% in patients treated with sequential therapies. Conclusions: The eradication rate of H. pylori with tailored therapies using the DPO-PCR test was acceptable. However, sequential therapies were not effective in patients who did not respond to clarithromycin.

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“…However, by using the same regimen, a novel study from Turkey including 113 children, did not show any superiority of sequential treatment over standard therapy (19). Although both studies have found clarithromycin resistance rate to be 25%, Ertem et al did not find any advantage of the sequential treatment.…”

Section: Discussionmentioning

confidence: 92%

Ornidazole-based sequential therapy is not effective in Helicobacter pylori eradication in children

Baysoy

In²,

Uslu³

et al. 2013

Turk J Gastroenterol

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Sequential therapy versus standard triple therapy for Helicobacter pylori eradication in children

Abstract: In this study, standard triple treatment failed to eradicate H. pylori infection in the majority of the children, and sequential therapy offered only a small advantage over standard triple therapy in the eradication of CLA-resistant strains.

Cited by 24 publications

References 40 publications

Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

A Pilot Study ofHelicobacter pyloriEradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Ornidazole-based sequential therapy is not effective in Helicobacter pylori eradication in children

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