The prolongation of triple therapy for Helicobacter pylori does not allow reaching therapeutic outcome of sequential scheme: a prospective, randomised study

Francesco, Vincenzo De; Zullo, Angelo; Hassan, Cesare; Valle, N. Della; Pietrini, L.; Minenna, M.F.; Winn, Simon; Monno, Rosa; Stoppino, V.; Morini, Sergio; Pañella, C.; Ierardi, Enzo

doi:10.1016/j.dld.2003.12.015

Cited by 69 publications

(53 citation statements)

References 31 publications

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“…However, the eradication rate following the standard triple therapy is declining worldwide and this necessitates the introduction of new antimicrobial agents [De Francesco et al 2004]. In view of the in vivo and in vitro activities against H. pylori, the use of different strains of probiotics in the treatment of H. pylori may be justifiable.…”

Section: Introductionmentioning

confidence: 99%

Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial

Emara

Mohamed

Abdel-Aziz

2013

Therap Adv Gastroenterol

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Introduction: The eradication rate of Helicobacter pylori following the standard triple therapy is declining. This study was conducted to test whether the addition of Lactobacillus reuteri to the standard triple therapy improves the eradication rates as well as the clinical and pathological aspects in H. pylori infection. Methods: A total of 70 treatment-naïve patients were randomly assigned into group A (the L. reuteri treated group) and group B (the placebo control group). Patients were treated by the standard triple therapy for 2 weeks and either L. reuteri or placebo for 4 weeks. They were examined by symptom questionnaire, H. pylori antigen in stool, upper endoscopy with biopsies for rapid urease test and histopathological examination before treatment and 4 weeks after treatment. Results: The eradication rate of H. pylori infection was 74.3% and 65.7% for both L. reuteri and placebo treated groups, respectively. There was a significant difference regarding the reported side effects, where patients treated with L. reuteri reported less diarrhea and taste disorders than placebo group. A significant difference within each group was observed after treatment regarding Gastrointestinal Symptom Rating Scale (GSRS) scores; patients treated with L. reuteri showed more improvement of gastrointestinal symptoms than the placebo treated group. The severity and activity of H. pylori associated gastritis were reduced after 4 weeks of therapy in both groups. The L. reuteri treated group showed significant improvement compared with the placebo treated group. Conclusion: Triple therapy of H. pylori supplemented with L. reuteri increased eradication rate by 8.6%, improved the GSRS score, reduced the reported side effects and improved the histological features of H. pylori infection when compared with placebo-supplemented triple therapy.

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Section: Introductionmentioning

confidence: 99%

Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial

Emara

Mohamed

Abdel-Aziz

2013

Therap Adv Gastroenterol

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“…Posteriormente, se compararon los dos regímenes utilizando la misma duración de tratamiento. La terapia secuencial y la triple terapia durante 10 días fueron igualmente efectivos en pacientes ulcerosos (36/36 [100%] frente a 32/34 [94,1%]), pero el tratamiento secuencial fue más efectivo en pacientes con dispepsia no ulcerosa (el 93,6 frente al 77,2%) 8 . Del mismo grupo de investigadores surge un estudio 5 que intenta mejorar el coste terapéutico del tratamiento secuencial, disminuyendo la dosis de claritromicina a 250 mg/12 h, sin encontrar diferencias significativas en cuanto a la tasa de erradicación ni a la curación endoscópica de las úlceras, manteniendo la tasa de curación en un 93%.…”

Section: Discussionunclassified

“…En Corea se han publicado los resultados de un estudio comparativo entre las dos pautas sin hallarse diferencias significativas en cuanto a la eficacia 11 . En comparación con el tratamiento triple estándar, el tratamiento secuencial no parece verse afectado por los factores )predictores* de fracaso del tratamiento triple como la ausencia del gen Cag A, el hábito tabáquico 12 o la indicación de dispepsia no ulcerosa 4,8 . La resistencia a la claritromicina reduce la eficacia del tratamiento secuencial, pero el descenso es significativamente menor que en la triple terapia [13][14][15] .…”

Section: Discussionunclassified

¿Cuál es actualmente el tratamiento erradicador de Helicobacter pylori de primera elección: la terapia triple (inhibidores de la bomba de protones [IBP], amoxicilina y claritromicina) o la terapia secuencial (IBP y amoxicilina durante 5 días, seguido de IBP, claritromicina y metronidazol durante otros 5 días)?

Sánchez-Delgado

2009

Gastroenterología y Hepatología

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“…This treatment seems to be equally effective in patients with ulcer and in those without and achieves excellent cure rates even in patients with clarithromycin resistance [58,59,60]. Interestingly, it is the first alternative therapy that has proved superior to triple therapy in a large randomized trial.…”

Section: H Pyloritreatment: Recent Developmentsmentioning

confidence: 99%

“…Among the new promising alternatives to triple therapy, a 10-day sequential therapy combining a 5-day course of PPI with amoxicillin immediately followed by a second course of clarithromycin, metronidazole and a PPI for 5 additional days was recently described [58,59,60,61,62]. This treatment seems to be equally effective in patients with ulcer and in those without and achieves excellent cure rates even in patients with clarithromycin resistance [58,59,60].…”

Section: H Pyloritreatment: Recent Developmentsmentioning

confidence: 99%

<i>Helicobacter pylori</i> Infection: Treatment Options

Calvet

2006

Digestion

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After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy – 7–10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin – followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures. Regrettably, present cure rates for first-line triple therapy are below 80%, and many patients require second-line treatment with further testing and control visits. Although most compliant patients are cured by the second-line treatment, patients often do not complete the full process and, as a result, final cure rates for the whole strategy often fall below 90%. This means that more effective first-line therapies are required. Promising recent developments include using quadruple therapy as first-line therapy, the use of adjuvant lactoferrin with triple therapy and a newly devised combination of a PPI, clarithromycin, amoxicillin and metronidazole, known as sequential treatment. Additional future developments will re quire the incorporation of new antibiotic weapons in the anti-H. pylori arsenal. The new quinolones and rifamycin derivates have recently demonstrated their efficacy in the treatment of H. pylori infection.

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The prolongation of triple therapy for Helicobacter pylori does not allow reaching therapeutic outcome of sequential scheme: a prospective, randomised study

Cited by 69 publications

References 31 publications

Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial

Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial

<i>Helicobacter pylori</i> Infection: Treatment Options

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