The DU‐MACH study: eradication of Helicobacter pylori and ulcer healing in patients with acute duodenal ulcer using omeprazole based triple therapy

Abstract

Aim : To investigate the efficacy of two omeprazole triple therapies for the eradication of Helicobacter pylori, ulcer healing and ulcer relapse during a 6‐month treatment‐free period in patients with active duodenal ulcer. Methods : This was a double‐blind, randomized study in 15 centres across Canada. Patients (n = 149) were randomized to omeprazole 20 mg once daily (O) or one of two 1‐week b.d. eradication regimens: omeprazole 20 mg, metronidazole 400 mg and clarithromycin 250 mg (OMC) or omeprazole 20 mg, amoxycillin 1000 mg and clarithromycin 500 mg (OAC). All patients were treated for three additional weeks with omeprazole 20 mg once daily. Ulcer healing was assessed by endoscopy after 4 weeks of study therapy. H. pylori eradication was determined by a 13C‐urea breath test and histology, performed at pre‐entry, at 4 weeks after the end of all therapy and at 6 months. Results : The intention‐to‐treat (intention‐to‐treat) analysis contained 146 patients and the per protocol (per protocol) analysis, 114 patients. The eradication rates were (intention‐to‐treat/per protocol): OMC—85% and 92%, OAC—78% and 87% and O—0% (O). Ulcer healing (intention‐to‐treat) was greater than 90% in all groups. The differences in the eradication and relapse rates between O vs. OMC and O vs. OAC were statistically significant (all, P < 0.001). Treatment was well tolerated and compliance was high. Conclusion : The OMC and OAC 1‐week treatment regimens are safe and effective for eradication, healing and the prevention of relapse in duodenal ulcer patients.

Dual proton pump inhibitor plus amoxicillin as an empiric anti-H. pylori therapy: studies from the United States

“…Recent studies have shown that triple therapy for Helicobacter pylori infection using amoxicillin, clarithromycin, and a proton pump inhibitor for 7 to 14 days is generally successful in less than 80% of patients [1][2][3][4][5][6][7][8][9][10][11][12]. Reduced treatment success has led to interest in developing more effective treatment regimens such as sequential and concomitant nonbismuth-containing 4-drug therapies, as well as renewed interest in older therapies such as bismuthcontaining quadruple therapy and proton pump inhibitor (PPI) plus amoxicillin therapy (dual therapy) [13,14].…”

Comparison of 7- and 14-day first-line therapies including levofloxacin in patients with Helicobacter pylori positive non-ulcer dyspepsia

“…The success rate of this treatment varies widely, ranging from 80 to 96% (4)(5)(6). Many studies on the efficacy of triple therapy have reported poor results, especially in some Mediterranean regions (7,8).…”

Short-term Celecoxib intervention is a safe and effective chemopreventive for gastric carcinogenesis based on a Mongolian gerbil model

“…Despite this, although the eradication of H pylori is still the most cost-effective method for prevention of gastric carcinogenesis, the antibiotic treatment of H pylori infection is confronting a significant challenge associated with resistance to antibiotics. The first-line regimen continues to have a 10%-23% failure rate [5][6][7][8][9][10] . Unfortunately, several studies have shown that rescue regimens have failed in 5%-63% of patients whose H pylori cannot be eradicated by standard PPI-based triple therapies [11,12] .…”