Bismuth-Based First-Line Therapy for <i>Helicobacter pylori</i> Eradication in Type 2 Diabetes Mellitus Patients

Abstract

Background/Aim: The primary aim of this study was to assess the efficacy of a bismuth-based quadruple regimen as first-line therapy for Helicobacter pylori (HP) eradication in diabetes mellitus (DM) patients. The secondary aim was to study the effect of HP eradication on dyspeptic symptoms in DM patients. Method: Eighty-nine consecutive type 2 DM and 48 non-diabetic age- and sex-matched patients were enrolled in this study. Diabetic patients were randomized to receive either pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1 g b.i.d., PCA-DM group) for 14 days, or pantoprazole (40 mg b.i.d.), bismuth citrate (400 mg b.i.d.), tetracycline (500 mg q.i.d.), and metronidazole (500 mg b.i.d., PBTM-DM group) for 14 days as the eradication regimen. All non-diabetic patients were treated by quadruple therapy (PBTM-non-DM group) for 14 days. We used the validated Leeds Dyspepsia Questionnaire (LDQ) to assess dyspeptic symptoms at baseline and 6 weeks after the end of treatment. Results: The HP eradication rates with intention-to-treat (ITT) and per-protocol (PP) analyses were 51% (for both) in the PCA-DM group; 81 and 85% in the PBTM-DM group, and 85 and 87% in the PBTM-non-DM group. The eradication rates are not different between the PBTM-DM and PBTM-non-DM groups (p > 0.05). The eradication rate was significantly lower in the PCA-DM group with both ITT and PP analysis than in the PBTM-DM and PBTM-non-DM groups (p < 0.05). LDQ score was 4.53 ± 7.7 in DM patients with successful eradication and 14.68 ± 5.9 in DM patients without successful eradication (p < 0.05). Conclusion: The bismuth-based quadruple eradication regimen as first-line therapy is safe, tolerable and achieves a high cure rate in patients with DM, and successful eradication may be beneficial on dyspeptic symptoms.

Helicobacter pylori eradication in patients with type 2 diabetes mellitus: Multicenter prospective observational study

“…9,21,22 Studies for the effect of type 2 diabetes on the eradication rate of H. pylori treatment are limited, 2,8,9,23–25 but they showed similar results of lower eradication rate compared to non-diabetic controls with standard triple antibiotics for 7–14 days, except one study showing similar eradication rate between two groups treated with bismuth-based quadruple regimen for 14 days. 26 Recently, one retrospective study reported similar eradication rate between type 2 diabetic patients and non-diabetic subjects with standard triple antibiotics for 7–14 days. 27 The proposed mechanism of lower eradication rate in diabetic patients is impaired gastric mucosal microvasculature leading to reduced antibiotics absorption, frequent antibiotic usage in diabetic patient group due to recurrent bacterial infections, and immunosuppressive condition of diabetes.…”

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

“…In the study by Demir et al [21] of 89 type 2 diabetic patients, the eradication rate was 51% with standard triple therapy (PPI, clarithromycin and amoxicillin) and this could be increased by a quadruple regimen (pantoprazole, bismuth, tetracycline and metronidazole) to 85%. The eradication rate was significantly lower in the DM group than in the non-DM group.…”

Effects of Alpha Tocopherol and Ascorbic Acid on Helicobacter pylori Colonization and the Severity of Gastric Inflammation

“…Antibiotics are not the only determinant of the success of H. pylori eradication therapy but host‐related factors also affect the eradication rate of any given therapy [9–11]. H. pylori creates a microenvironment to protect itself from gastric acid and host defense systems, and increases oxidative stress in areas it colonizes [2].…”