Which is the best choice for Helicobacter pylori eradication? Dual therapy or quadruple therapy?

Abstract

Introduction: Standard triple therapy used to be the first-line treatment for Helicobacter pylori (Hp) infection, but today it is a treatment regimen with a low eradication rate due to increasing resistance to the antibiotics included in the triple therapy.Aim: To compare the eradication rates of dual treatment regimens and quadruple treatment regimens.Material and methods: Patients over 18 years of age, who were indicated to undergo upper gastrointestinal system (GIS) endoscopy for any reason, had their upper gastrointestinal endoscopy performed, were detected to have Hp as a result of the histopathological evaluation of the biopsy material, and in whom eradication control was also performed by histopathological evaluation, were included in the study. These patients were divided into 4 groups, each containing 50 people.Results: Considering the eradication rates of Hp-positive patients according to different treatment options, 78% (n = 39) of the patients in Group 1 were eradicated after the treatment while 66% (n = 33) of the patients in Group 3, 58% of the patients in Group 2 (n = 29), and 58% (n = 29) of the patients in Group 4 had Hp negative results after treatment. When high-dose dual treatments were compared, the highest eradication rate was obtained with rabeprazole, but no statistically significant difference was detected (p = 0.11).Conclusions: This is the first study to include dual therapies consisting of 3 different PPIs at the same time. The low eradication rates obtained in our study suggest that the determination of individualized treatment strategies in which CYP2C19 polymorphism is detected may result in higher eradication rates.

High-dose dual therapy versus bismuth-containing quadruple therapy for the treatment of helicobacter pylori infection: A meta-analysis of randomized controlled trials

“…Finally, 5604 participants from14 RCTs were enrolled in this meta-analysis [ Figure 1 ]. Noteworthy, 3 studies[ 7 15 16 ] were not included because the patients were not treatment-naive while another study[ 8 ] was not included because the therapeutic regimen was unclear, and the results were not distinguished by ITT and PP analysis.…”

“…[ 7 ] concluded that HDDT could achieve a comparably higher eradication rate than BQT, while Bacaksız et al . [ 8 ] showed that HDDT embraced a low eradication rate compared with BQT. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of HDDT versus BQT in eradicating H. pylori .…”

Phenotype and genotype analysis for Helicobacter pylori antibiotic resistance in outpatients: a retrospective study

“…However, they are ineffective in more than 20% of patients, mainly due to the increasing resistant strains of one or more antibiotics used in these therapies ( 10 ). According to Maastricht V consensus suggestion, bismuth-containing quadruple therapy was recommended as the first-line treatment in regions where the clarithromycin (CLR) resistance rate exceeded 15%–20% ( 11 ). However, the decline in the eradication rate of H. pylori was due to multiple factors, including increased antibiotic resistance rate, low patient compliance, high bacterial load ( 5 ), and genotype of cytochrome P450 proteins 2C19 (CYP2C19) gene ( 7 ).…”