Tratamiento erradicador de Helicobacter pylori. Recomendaciones de la Conferencia Española de Consenso

Gisbert, Javier P.; Calvet, Xavier; Gomollón, Fernando; Sainz, Ricardo Calle

doi:10.1016/s0025-7753(00)71237-1

Cited by 84 publications

(16 citation statements)

References 54 publications

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“…Another alternative, the use of a quadruple regimen (i.e. PPI, bismuth, tetracycline and metronidazole), has been generally used as the optimal second-line therapy after PPI-clarithromycin-amoxicillin failure, and has been the recommended 'rescue' regimen in several guidelines [Malfertheiner et al 2007;Gisbert et al 2000a;Lam and Talley, 1998]. Several studies have obtained relatively good results with this quadruple regimen, the results being summarized in Table 1 [Usta et al 2008;Uygun et al 2008;Chung et al 2007;NavarroJarabo et al 2007;Choung et al 2006, Wu et al 2006Lee et al 2005Lee et al , 1999Marko et al 2005;Bilardi et al 2004;Nista et al 2003;Orsi et al 2003;Perri et al 2003Perri et al , 2001aWong et al 2003;Baena Diez et al 2000;Michopoulos et al 2000;Sicilia et al 2000;Gasbarrini et al 2000b;Gomollon et al 1999;Gisbert et al 1999aGisbert et al , 1999bElizalde et al 1998].…”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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“…Many of the current H. pylori treatment guidelines implicitly or explicitly incorporate both these data and the concept of therapeutic strategy [17, 18]. With small discrepancies, first-line and second-line treatments coincide with those shown in figure 1.…”

Section: H Pylori Treatment: Current Status and Guidelinesmentioning

confidence: 86%

“…1 Current recommended treatment strategy for H. pylori infection. PPI = Proton-pump inhibitor (adapted from Gisbert et al [18]). …”

Section: H Pylori Treatment: Current Status and Guidelinesmentioning

confidence: 99%

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<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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“…infection, we dispose of invasive tests like histology, cultures, molecular tests and rapid urease test which are dependent on the taking of biopsies from the gastric mucosa through an upper digestive endoscopy and of none invasive tests which do not require upper endoscopy like serology, urea breath test or the detection of stool antigens (1)(2)(3).…”

Section: For the Diagnosis Of Helicobacter Pylori (H Pylori)mentioning

confidence: 99%

Chromoendoscopy with red phenol in the diagnosis of Helicobacter pylori infection

Hernández‐Garcés¹,

Castellanos-González²,

González-Fabián

et al. 2012

Rev. esp. enferm. dig.

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An analytic study to validate a diagnostic test was carried out at the Institute of Gastroenterology in Havana, Cuba in adult patients of both sexes in whom chromoendoscopy was carried out with red phenol at 0.1% over the gastric mucosa for the detection of Helicobacter pylori infection between November 2008 and December 2010. The staining with red phenol at 0.1% is included in the invasive tests for the diagnosis of Helicobacter pylori infection and of the reactive techniques. The sensibility of red phenol dye in the diagnosis of Helicobacter pylori infection in the patients studied was of 72.6% with a confidence interval (C.I.) of 95% (64.9 to 79.2%) and a specificity of 75.5% C.I. 95% (61.9 to 85.4%). The positive predictive value was of 89.8% C.I. 95% (83.1 to 94.1%) and the negative predictive value of 48.1% C.I. 95% (37.3 to 59.0%). The proportion of false positives was of 24.5% C.I. 95% (14.6 to 38.1%) and the proportion of false negatives was of 27.4% C.I. 95% (20.8 to 35.1%). The diagnostic accuracy of the dye on the patients studied was 73.3% C.I. 95% (66.7 to 79.0%). The diagnostic odds ratio was 8.17 C.I. 95% (3.88 to 17.23), the J Youden ratio of 0.5 and the Kappa coefficient of 0.40 C.I. 95% (0.27 to 0.54). The staining dye with red phenol at 0.1% resulted in a useful method in the diagnosis of Helicobacter pylori infection in the gastric mucosa, it can be applied in our environment and has multiple advantages (topographic localization, avoids contamination and fast and immediate reading).

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Tratamiento erradicador de Helicobacter pylori. Recomendaciones de la Conferencia Española de Consenso

Cited by 84 publications

References 54 publications

Review: Second-line rescue therapy of Helicobacter pylori infection

Review: Second-line rescue therapy of Helicobacter pylori infection

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

Chromoendoscopy with red phenol in the diagnosis of Helicobacter pylori infection

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