The appropriate cutoff gastric pH value for Helicobacter pylori eradication with bismuth‐based quadruple therapy

Abstract

Background This study aimed to investigate whether an increased proton pump inhibitor (PPI) dose enhanced the efficacy of Helicobacter pylori (H. pylori) eradication and determine the appropriate cutoff intragastric pH value that could predict H. pylori eradication with bismuth‐based quadruple therapy. Materials and Methods A total of 207 H. pylori infected, treatment naive patients were enrolled in this prospective, open‐label, randomized controlled trial. Patients were randomly allocated into Eso40‐group (esomeprazole 40 mg bid) and Eso20‐group (esomeprazole 20 mg bid), and their CYP2C19 genotyping status was assessed. The 24‐h intragastric pH monitoring on day 7 was performed, and percentage of time gastric pH ≥ 3, ≥4, ≥5, and ≥6 (pH holding time ratios; HTRs) were measured. H. pylori eradication was evaluated using 13C‐urea breath test. Results No significant difference in the eradication rates was observed between two groups. The median 24‐h intragastric pH value was not significant different between two groups but the Eso40 Group had a significant higher pH4 HTRs (91.11% [95%CI: 87.50%–95.83%] vs. 95.83% [95.83%–100%]; p = .002). Additionally, the median 24‐h intragastric pH value showed significantly difference between two groups in EM genotype (Eso20 Group 6.00 [95%CI; 5.75–6.15] vs. Eso40 Group 6.30 [6.05–6.30]; p = .019). Similar results were observed in pH4 HTRs. There were significant differences in intragastric pH value (6.10 [95%CI: 4.40–7.00] vs. 5.65 [4.85–5.95], p = .038) and in pH4 HTRs (96% [95%CI: 92.00%–96.00%] vs. 87.5% [67.00%–100.0%], p = .019) between eradication‐successful and eradication‐failed patients. Statistical analysis suggested that the median intragastric pH = 5.7 could identify the success of H. pylori eradication. Conclusions Bismuth‐based quadruple therapy resulted in high H. pylori eradication rates either in PPI standard or double doses. Double dose of esomeprazole is associated with better intragastric acid suppression. A median 24‐h intragastric pH of 5.7 could be appropriate cutoff value for predicting the successful H. pylori eradication.

Efficacy and safety of vonoprazan-based quadruple therapy for the eradication of Helicobacter pylori in patients with peptic ulcers: a pooled analysis of two randomized, double-blind, double-dummy, phase 3 trials

“…In addition, the H. pylori eradication rate among those infected with clarithromycin-resistant strains was signi cantly higher with vonoprazan-based vs lansoprazolebased triple therapy [21]. For successful H. pylori eradication, the median 24-h intragastric pH should be > 5.7 or the 24-h pH 5.0 holding time ratio (HTR) should be > 88% [33]. Conventional PPIs are unable to maintain such pH values at standard doses, while vonoprazan 20 mg twice daily inhibited gastric acid more potently than esomeprazole 20 mg twice daily and the 24-h median pH and pH 5.0 HTR reached 6.8 and 99%, respectively [34].…”

Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the United States and Europe: Randomized Clinical Trial

“…6 Therefore, sustained control of intragastric pH may improve H pylori eradication rates. 6,7 Vonoprazan is a potassium-competitive acid blocker, currently approved for the treatment of H pylori infection and other acid-related diseases in several countries, including Japan. It increases intragastric pH rapidly and potently and maintains it to a greater degree than PPIs; this has been associated with higher H pylori eradication rates.…”

Comparison of Vonoprazan and Amoxicillin Dual Therapy with Standard Triple Therapy with Proton Pump Inhibitor for Helicobacter Pylori eradication: A Randomized Control Trial

“…Major reason for decreased effectiveness was development of resistance to antibiotics and failure to maintain sustained increase in gastric pH of >5.7 during course of the day. [4][5][6] To overcome this double dose of Proton Pump Inhibitor (PPI) are used in all Hp eradication regimens to maintain high pH. Since PPI based therapy was found to be superior to non PPI based therapy for Hp eradication therefore the addition of anti-secretory drugs to antibiotic is of utmost importance in the eradication regimens.…”