10-day triple therapy with esomeprazole 40mg/12h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection

Campillo, Ana; Amorena, Edurne; Ostiz, Miriam; Kutz, Marcos; LaIglesia, Matilde

doi:10.1016/j.gastre.2016.10.007

Cited by 2 publications

(4 citation statements)

References 14 publications

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“…Concomitant therapy is similar to sequential in that it involves treatment with three antibiotics, but in contrast to sequential therapy, all three antibiotics are taken along with the PPI for the full duration of therapy . A study from Spain this year showed it to be superior to 10‐day triple therapy (85.9% vs 65.7%) . A meta‐analysis of studies from regions of China found concomitant therapy to be superior to triple therapies of varying (but usually 7‐day) regimens (91.2% vs 77.9%), but not significantly different from sequential therapy, albeit with better compliance for concomitant therapy .…”

Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 99%

“…23 A study from Spain this year showed it to be superior to 10-day triple therapy (85.9% vs 65.7%). 24 A meta-analysis of studies from regions of China found concomitant therapy to be superior to triple therapies of varying (but usually 7-day) regimens (91.2% vs 77.9%), but not significantly different from sequential therapy, albeit with better compliance for concomitant therapy. 25 Several studies this…”

Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 99%

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Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 99%

Section: Sequential Concomitant and Hybrid Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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“…Some study showed that concomitant therapy containing high-dose esomeprazole (40 mg) twice daily achieved a higher eradication frequency. 16,17 Whether the dosage of PPI and intragastric pH will affect the H. pylori eradication rate with Bismuth-containing quadruple therapy is not known. This study aimed to detect the influence of esomeprazole doses (40 mg vs. 20 mg) and CYP2C19 genotypes on the intragastric pH and thus determine the appropriate cutoff gastric pH value for predicting successful H. pylori eradication with bismuth-containing quadruple therapy.…”

Section: Introductionmentioning

confidence: 99%

“…The appropriate dose and frequencies of PPIs included in the regimen are important to achieve higher eradication frequency. Some study showed that concomitant therapy containing high‐dose esomeprazole (40 mg) twice daily achieved a higher eradication frequency 16,17 . Whether the dosage of PPI and intragastric pH will affect the H. pylori eradication rate with Bismuth‐containing quadruple therapy is not known.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

Helicobacter

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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.

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10-day triple therapy with esomeprazole 40mg/12h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection

Cited by 2 publications

References 14 publications

Treatment of Helicobacter pylori infection 2017

Treatment of Helicobacter pylori infection 2017

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

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