The <i>Helicobacter pylori</i> Eradication Rate in a High Prevalence Area (West Africa): Three Triple Therapy Comparative Study

Abstract

In Western countries, the current trend is to use sequential quadruple therapy or bismuth-based instead of triple therapy for the eradication of Helicobacter pylori (H. pylori). In sub-Saharan Africa, high prevalence area of the H. pylori infection, the effectiveness of these triple therapies widely used in routine has been little evaluated. The purpose of this study was to evaluate and compare the effectiveness of three patterns of first-line triple therapy based on combining a proton pump inhibitors (PPI), and 3 types of antibiotics: omeprazole (O), amoxicillin (A), clarythromycin (C) and metronidazole (M). Patients and Methods: This is a randomized clinical trial opened on 3 parallel arms: OAM (group 1 or G1), OAC (group 2 or G2) or OCM (group 3 or G3). The primary endpoint was H. pylori eradication rate after seven days triple therapy. H. pylori diagnosis infection was based on bacterium detection on the histological examination of the gastric biopsies. Histological control was performed 4 weeks after the end of treatment to assess H. pylori eradication rate. Results: The average age of our 153 patients included in the study (86 men) was 44.33 ± 11.72 years. The main reason of the endoscopy was the dyspeptic syndrome (75.16%). The gastroscopy was normal in 28.76%. A Gastric or duodenal peptic ulcer was found in 17% of cases and gastropathy in 45.75%. Histologically, the GC was active in 90.9% of cases, follicular in 35.3% of cases, atrophic in 22.5% of cases and was associated with intestinal metaplasia (IM) in 5.2% of cases. Patients of these three groups (n = 64 for G1, n = 56 for G2 and n = 33 for G3) were comparable for age, gender, endoscopy indications, alcohol consumption history or smoking, and A. S. Doffou et al. 201 anti-inflammatory drugs taking. Approximately 23% of patients experienced adverse reactions. The overall H. pylori eradication rate was 22.3%. There was no significant difference H. pylori eradication rate depending on the treatment used (28.1%, 21.4% and 15.1% for G1, G2 and G3, p = 0.34). Conclusion: The H. pylori eradication rate was poor regardless of the triple therapy used. It is desirable in the absence of bacteriological data on the primary and secondary resistance levels to optimize the eradication rate advocating the use of quadruple therapy at outset in first-line.

Evaluation of Three Helicobacter pylori Eradication Protocols in a Digestive Endoscopy Center in Dakar

“…The very low eradication rate obtained with triple AOM therapy (28.2%) is also reported in the literature [8] [10] [16]. The sometimes-abusive use of metronidazole in our regions, linked to the frequency of parasitic diseases, could explain the resistance of Hp to this molecule and the inefficiency of this triple therapy.…”

“…An eradication rate of 21.4% was found in an Ivorian study [16]. In North Africa, Europe and the Middle East, the efficacy of AOC treatment was also below the threshold set by the learned societies (80%).…”

Helicobacter pylori Infection and Its Risk Factors: A Prospective Cross-Sectional Study in Resource-Limited Settings of Northwest Ethiopia

“…Magnitude of H. pylori among the outpatient department (based on a test kit detecting Immunoglobulin G (IgG) antibodies) at the University of Gondar Hospital (UOG Hospital) was ranged between 65.7% and 85.6% [ 13 , 14 ]. Besides, it is a common reason to seek primary healthcare service and accounts for 10% of hospital admissions [ 15 , 16 ].…”