Clinical factors associated with initial Helicobacter pylori eradication therapy: a retrospective study in China

Abstract

The eradication rate of Helicobacter pylori (H. pylori) has been decreasing every year, mainly due to the increase in antibiotic resistance. In fact, many other factors may affect H. pylori eradication. To analyze the clinical factors affecting the initial eradication therapy in Chinese patients with H. pylori infection. We conducted a retrospective study on 264 outpatients who were diagnosed with H. pylori-associated chronic gastritis and peptic ulcer disease between January and December 2015 at a large tertiary hospital in China. The patients were divided into three groups: ECA, RCA, and RCM (R: 20 mg rabeprazole, E: 40 mg esomeprazole, C: 0.5 g clarithromycin, A: 1.0 g amoxicillin and M: 0.4 g metronidazole). The patients were treated for 14 days and followed up for 1 year. The 14C-urea breath test (14C-UBT) was performed 4 weeks after the completion of the eradication therapy. The eradication rate was higher in ≥ 40-year-old patients than in < 40-year-old-patients (85.7% vs. 54.7%, p = 0.002). Multivariate analyses revealed only age ≥ 40 years to be significantly associated with a high H. pylori eradication rate [odds ratio (OR) 4.58, p = 0.003]. The H. pylori eradication rate in patients with duodenal ulcers was significantly higher than that in patients with gastric ulcers (79% vs. 60%, p = 0.012). Age could be a predictor of successful H. pylori eradication. Patients with duodenal ulcers had a higher H. pylori eradication rate than those with other lesions.

The Emergence of Multidrug-Resistant Helicobacter pylori in Southeast Asia: A Systematic Review on the Trends and Intervention Strategies Using Antimicrobial Peptides

“…Taken together, these results suggest that the primary treatment consisting of quadruple therapy or sequential therapy must be administered to H. pylori -infected patients in SEA countries with high prevalence of clarithromycin resistance, provided clinical data of patients are available prior to the administration. Besides clarithromycin resistance in H. pylori , clinical factors that contribute to first-line treatment failure also include the patient’s non-compliance during therapy period, the patient’s age (eradication was more successful in older patients), and the type of ulcer, in which eradication was significantly more successful in duodenal ulcers compared to gastric ulcers, which should be taken into consideration before switching to quadruple treatment [ 47 ].…”

Persistent Helicobacter pylori Infection: An Insight to the Limitations of Current Clinical Practice

“…Thus, high-dose dual therapy (amoxicillin and PPI) and rifabutin-based therapy are recommended as third and fourth-line treatments, depending on an individual’s previous treatment course. Resistance to antibiotics, particularly clarithromycin, remains a crucial factor affecting H. pylori eradication therapy [ 10 ]. Practitioner's familiarity with the available treatment regimens, local resistance rates, and the patient’s previous antibiotic use is paramount to determine initial therapy of choice to mitigate the impact of resistance.…”

Efficacy of Helicobacter pylori eradication therapy for treatment of functional dyspepsia

“…The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement guidelines. [ 8 ] Ethical approval is not necessary because this is a meta-analysis.…”

“…[ 6 ] Therefore, there have been many studies on whether H pylori eradication therapy is effective in relieving the symptoms of dyspepsia. [ 7 , 8 ] However, the effect of eradication therapy in FD patients was inconsistent in previously published randomized controlled trials because of variable study designs and follow-up durations. Therefore, we performed a comprehensive protocol for systematic review and meta-analysis in order to assess the overall clinical impact of H pylori eradication therapy in patients with FD.…”