Cetraxate, a mucosal protective agent, combined with omeprazole, amoxycillin, and clarithromycin increases the eradication rate of Helicobacter pylori in smokers

Abstract

There is now strong evidence that Helicobacter pylori infection plays an important role in the pathogenesis of peptic ulcer disease, and many studies have shown that eradicating H. pylori can markedly decrease ulcer relapse. 1±3 A number of studies have reported that the eradication rate achieved using omeprazole in combination with two antimicrobial agents was more than 90%. 4±6 However, such treatment fails in 5±10% of patients.Recent studies have indicated that factors such as the patient's compliance with treatment, as well as age, gender, smoking habits, proton-pump inhibitor pretreatment, and clinical diagnosis have an in¯uence on the ef®cacy of H. pylori eradication therapy. 7±16 Additionally, our previous study demonstrated that eradication of H. pylori by treatment with omeprazole, amoxycillin, and clarithromycin (OAC) was less effective in smokers than in non-smokers. 17 Smoking decreases gastric blood¯ow and mucus secretion, and thus may reduce the ef®cacy of treatment by decreasing the delivery of antibiotics to the gastric mucosa. 18±21 SUMMARYBackground: Our previous study demonstrated that Helicobacter pylori eradication was less effective in smokers than in non-smokers. Cetraxate is an antiulcer drug that increases gastric mucosal blood¯ow. Aim: To evaluate the effect of cetraxate combined with new triple therapy for the eradication of H. pylori in smokers. Methods: This study had a single-centre, double-blind, randomized non-placebo design. A total of 106 consecutive H. pylori-positive smoking patients were randomly allocated to one of two regimens: one group received omeprazole (20 mg), amoxycillin (1500 mg), and clar-

A randomized open trial for comparison of proton pump inhibitors, omeprazole versus rabeprazole, in dual therapy for Helicobacter pylori infection in relation to CYP2C19 genetic polymorphism

“…Whether smoking decreases the cure rate in this triple therapy regimen is also still controversial. Recently, the addition of cetraxate, a mucosal protective drug, to the new triple regimen has been shown to increase the cure rate in smokers, 35 but the dose of PPI (omeprazole) used in that study was 20 mg/day, half of the usual dose for the new triple therapy. The effect of smoking on the cure rate in triple therapy regimens in Japanese patients in relation to other factors such as CYP2C19 genetic polymorphism and antibiotic resistance should be clarified by future study.…”

The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis

“…Several factors have been found to affect the efficacy of standard triple therapies, such as bacterial resistance to antibiotics, 15 compliance to therapy, 21 bacterial load in the stomach, [25][26][27] CagA status, 38 smoking habit, 53 and gastroduodenal pathology. 48 However, among these factors, both bacterial clarithromycin resistance and patient compliance to the therapy play a major role in predicting the therapeutic outcome.…”

Efficacy of Triple Therapy Plus Cetraxate for the Helicobacter pylori Eradication in Partial Gastrectomy Patients

“…Tachi et al showed that cetraxate might enhance nitric oxide synthase activity and prevent a decrease in the mucosal prostaglandin content, resulting in an increase in gastric mucosal blood flow (30). The addition of cetraxate also has been reported to improve the eradication rate of H. pylori (31). To confirm the efficacy of this method, statistical analysis with a large number of cases was additionally performed.…”