Effects of patient age and choice of antisecretory agent on success of eradication therapy for <i>Helicobacter pylori</i> infection

Abstract

The effects of patient age on the efficacy of eradication treatment for Helicobacter pylori (H. pylori) remain unclear. The present study aimed to determine whether age affects eradication therapy involving vonoprazan, a novel potassium-competitive acid blocker (PCAB). We reviewed the cases of 3,261 patients who were administered first-line and second-line H. pylori eradication therapy at Toyoshima Endoscopy Clinic. The first-line treatment was clarithromycin and amoxicillin combined with a proton pump inhibitor (PPI) or a PCAB. The second-line treatment was metronidazole and amoxicillin combined with a PPI or PCAB. The patients were divided into a young to middle-aged group (age ≤50 years) and an older group (age >50 years) as well as into PPI and PCAB groups. The PPI-clarithromycin-amoxicillin regimen demonstrated a significantly lower H. pylori eradication rate than the PCAB-clarithromycin-amoxicillin regimen (p<0.001). With the PPI-clarithromycin-amoxicillin regimen, the eradication rate in the young to middle-aged group was significantly lower than that in the older group (p<0.001). Lastly, age had no impact on the eradication rate of PCAB-based therapy or metronidazole-based therapy. In conclusion, with clarithromycin-based triple therapy, PCAB is a better choice of antisecretory agent compared to PPIs, especially in young to middle-aged patients.

A Potassium-Competitive Acid Blocker-Based Regimen as Second-Line Therapy Improves Helicobacter pylori Eradication

“…Unlike the present study, recent Japanese retrospective studies of second-line H. pylori eradication therapy did not show a significant difference between PCAB and PPIbased regimens [21][22][23][24][25]. However, 4 studies showed a trend of superiority of PCAB over PPI-based regimens by 4-6% for second-line eradication success [21,22,24,25]. We can suggest 2 possible explanations why the past studies did not show statistically significant differences.…”

Review: A Japanese population‐based meta‐analysis of vonoprazan versus PPI for Helicobacter pylori eradication therapy: Is superiority an illusion?

“…A total of 133 studies were identified in the PubMed, EMBASE, and Cochrane Library databases. After reviewing the titles, abstracts, and full texts, we ultimately included 14 studies in the meta‐analysis. The detailed selection process is shown in Figure .…”

“…The detailed selection process is shown in Figure . In the 12 included studies, there are 2 well‐designed RCTs and 12 retrospective studies . The basic characteristics of all of the included studies are presented in Table .…”

Treatment of Helicobacter pylori infection in 2018

“…Treatment failure occurred more frequently in patients with 25‐OH vitamin D deficiency, whereas supplementing eradication therapy with vitamin C and E has no effect . A Japanese study found lower eradication rates with standard triple therapy in younger cohorts, perhaps reflecting poorer compliance …”

“…80 A Japanese study found lower eradication rates with standard triple therapy in younger cohorts, perhaps reflecting poorer compliance. 81…”