Eradication Therapy with Rabeprazole versus Omeprazole in the Treatment of Active Duodenal Ulcer

Abstract

Background: Rabeprazole has been demonstrated to be a potent antisecretory agent and has been shown to be clinically effective in the treatment of acid-related diseases. Aims: It was to determine the efficacy of rabeprazole at 20 and 40 mg in addition to amoxicillin and clarithromycin in the treatment of active Helicobacter pylori-positive duodenal ulcers compared with omeprazole 40 mg. Patients and Methods: One hundred and twenty-seven patients were randomised into three treatment groups: 40 patients were treated with rabeprazole 40 mg daily, 42 patients with rabeprazole 20 mg daily and 45 patients with omeprazole 40 mg daily for 10 days. All patients received amoxicillin 1 g twice a day and clarithromycin 500 mg twice a day for 5 days. All patients were re-assessed at least 4 weeks after the end of the treatment. Results: According to the intention-to-treat (ITT) protocol, ulcer healing was observed in 90% of patients in the rabeprazole 40 group, in 85.7% in the rabeprazole 20 group and in 93.3% in the omeprazole 40 group. We observed H. pylori eradication in 90% ITT in the rabeprazole 40 group, in 80.9% ITT in the rabeprazole 20 group and in 88.8% ITT in the omeprazole 40 group. Statistical analysis did not show significant differences among the three groups. Conclusions: A 10-day rabeprazole 20 mg regimen represents an efficacious and safe regimen for H. pylori eradication and ulcer healing.

Meta‐analysis: esomeprazole or rabeprazole vs. first‐generation pump inhibitors in the treatment of Helicobacter pylori infection

“…Overall 35 (18.1%) studies of the 193 relevant references initially selected were included (4108 results on first step of the search). A flow chart of the multi‐step exclusion process is presented in Figure .…”

“…The studies, published between 1999 and 2011, presented the overall data of 7360 infected adult patients (Table ). Twenty studies compared rabeprazole with first‐generation PPIs (1795 patients in the rabeprazole arm vs. 1969 patients with the other PPIs), and 12 studies compared esomeprazole with first‐generation PPIs (1240 vs. 1358 patients respectively) . Five studies compared rabeprazole with esomeprazole (772 vs. 802 patients respectively) …”

“…A small improvement was found when excluding Catalano et al . () that used a once daily rabeprazole for 5 days in normal and low doses (40 and 20 mg od) (OR = 1.22). Sub‐analyses were performed for rabeprazole 10 mg b.d.…”

Sequential treatment for Helicobacter pylori eradication in duodenal ulcer patients: improving the cost of pharmacotherapy

“…Moreover, our data are in agreement with other recent studies in which a 10‐day course of proton pump inhibitor was administered 16 ,. 27 This observation is of great importance in clinical practice, as duodenal ulcer patients with persistent epigastric pain following the eradication regimen could be easily managed with antacids on demand without resorting to much more expensive proton pump inhibitor therapy. This therapeutic approach is further strengthened by the observation that antacids were required by only a minority of patients (< 7%).…”

Treatment of H. pylori Infection: A Review

“…The increasing incidence of resistance to clarithromycin explains the drop of eradication rate of AC treatments observed in recent years. Eradication rate of AC regimens [34][35][36][37][38][39][40][41][42][43] is about 80% (63-90%) Table (1) but it shows great variability in different geographic sites, due to the local prevalence of antibiotics resistance. Eradication rate of AC therapies in patients infected with clarithromycin resistant strains appears to be very low in all studies performed (0-40%) [30,33-35, 42,44].…”