Evidence that the Degree and Duration of Acid Suppression are Related to Helicobacter pylori Eradication by Triple Therapy

Sugimoto, Mitsushige; Furuta, Takahisa; Shirai, Naohito; Kodaira, Chise; Nishino, Masafumi; Ikuma, Mutsuhiro; Ishizaki, Takashi; Hishida, Akira

doi:10.1111/j.1523-5378.2007.00508.x

Cited by 137 publications

(155 citation statements)

References 32 publications

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“…In this study, advanced age showed a trend toward a higher eradication rate, and a large French study reported advanced age as a significant factor for successful eradication [14] . Gastric pH elevation increases the rate of successful eradication [15] . Although it has been reported that integrated acidity in the general population is not affected by age [16] , acidity in the elderly may be more suppressed by PPI than in younger people.…”

Section: Discussionmentioning

confidence: 99%

Elevated Serum anti-Helicobacter pylori IgG Levels is a Predictor of Successful Eradication Therapy

Shinozaki

Sakamoto

Hayashi

et al. 2015

Journal of Gastroenterology and Hepatology Research

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habits, prior PPI intake, kind of PPI, serum IgG value and degree of atrophy. Univariate analysis showed that high serum IgG significantly predicts successful eradication (odds ratio (OR) 2.583, 95% confidence interval (CI) 1. 285-5.191, p=0.008). The eradication rate was 77% (43/56) in the ≥45 U/mL group and 56% (73/130) in the <45 U/ mL group, and significance was confirmed by multivariate analysis (OR 2.626, 95% CI 1. 269-5.436, p=0.009). Multivariate analysis showed a trend that advanced age (≥70 year-old) increased the rate of successful eradication (OR 1.669, p=0.132 INTRODUCTIONHelicobacter pylori (H. pylori) eradication is the standard treatment for preventing gastric ulcers and cancer throughout the world. In Japan, H. pylori eradication therapy for H. pylori gastritis has been approved by the National Health Insurance system since February 2013. For primary eradication therapy, triple drug therapy including a proton pump inhibitor (PPI), clarithromycin and amoxicillin for one week is the approved regimen. Despite more patients undergoing this eradication regimen in Japan, the success rate of primary H. pylori eradication has been decreasing over the last decade because of emerging antibiotic resistance [1] . To identify a predictor of successful primary Helicobacter pylori (H. pylori) eradication assessed in routine clinical practice. METHODS: From February 2013 to January 2015, 186 patients underwent primary eradication therapy. We retrospectively reviewed the medical records. All patients underwent EGD before eradication therapy and H. pylori infection was diagnosed by ≥10 U/mL serum anti-H. pylori IgG. We used standard triple therapy including a proton pump inhibitor (PPI) (rabeprazole 10 mg or lansoprazole 30 mg), clarithromycin 200 mg and amoxicillin 750 mg twice daily for seven days. To determine if eradication succeeded, a 13 C-urea breath test was performed on all patients more than eight weeks after primary eradication. RESULTS: The overall success rate of H. pylori eradication therapy was 62% (116/186). We assessed potential predictors of successful primary H. pylori eradication therapy including gender, age, smoking

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Section: Discussionmentioning

confidence: 99%

Elevated Serum anti-Helicobacter pylori IgG Levels is a Predictor of Successful Eradication Therapy

Shinozaki

Sakamoto

Hayashi

et al. 2015

Journal of Gastroenterology and Hepatology Research

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“…With this eradication therapy, gastric pH rises due to the effects of the PPI and is maintained in the neutral range, allowing the antimicrobial agents to display good antimicrobial activity. Achieving sufficient gastric acid secretion-inhibiting effects is important, and a correlation is thought to exist between gastric pH and the success of H. pylori eradication therapy (14). RPZ is known to increase gastric pH to between 6 and 8 more rapidly and reliably than other PPIs and to effectively inhibit nocturnal secretion of gastric acid (15)(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Prospective Observational Study of Triple Therapy with Rabeprazole, Amoxicillin and Metronidazole for Helicobacter pylori in Japan

et al. 2012

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Objective Triple therapy with rabeprazole (RPZ), amoxicillin (AMPC) and metronidazole (MNZ) (RPZ+ AMPC+MNZ therapy: RAM therapy) has been approved by the Japanese Ministry of Health, Labour and Welfare as a second-line therapy for Helicobacter pylori-positive gastric and duodenal ulcers in Japan. The present multicenter prospective observational study aimed to investigate the safety and efficacy of RAM therapy in clinical practice. Methods Patients with H. pylori-positive gastric or duodenal ulcers (including ulcer scars) in whom firstline therapy was unsuccessful were administered 10 mg of RPZ, 750 mg of AMPC and 250 mg of MNZ twice daily for seven days (total: 14 doses) based on an approved dose and regimen. Patient background factors, including complications, previous medical history, concomitant drugs, eradication results and adverse events were recorded by the investigator. Results The incidence of adverse drug reactions was 2.21% and the H. pylori eradication rate was 92.8%. Subgroup analyses performed to investigate the patient background factors affecting safety and efficacy revealed no factors that significantly affected the incidence of adverse drug reactions or the H. pylori eradication rate. Conclusion Amid reports of decreased eradication rates with clarithromycin-based first-line therapy, the >90% H. pylori eradication rate achieved in the present study demonstrates the clinical efficacy of RAM therapy in subjects in whom first-line therapy is unsuccessful.

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“…Serum concentrations of esomeprazole (EPZ) and RPZ were less affected by the CYP2C19 polymorphism, Open Journal of Gastroenterology The main role of gastric acid-inhibitory agents in H. pylori eradication therapy is to increase the bioavailability and stability of antibacterial agents in the stomach [34]. In patients who achieved successful eradication with LPZ therapy, the median 24-hour pH was 6.4 (range 5.0 -7.6), which was higher than that in patients without eradication (pH 5.2, 2.2 -6.2), and the median percentage time of a pH < 4.0 during the 24-hour post-dose period in patients with eradication (0.5%) was significantly shorter than that in patients without eradication (26.7%) [35]. AMPC has poor stability, particularly at a low pH, but nevertheless has a half-life of over 15 hours at pH 2.…”

Section: Discussionmentioning

confidence: 69%

Gastric Mucosal Atrophy Might Be Associated with the Efficacy of First-Line Therapy Using Vonoprazan for Helicobacter pylori

Miura¹,

Ohtaka²,

Hanawa³

et al. 2017

OJGas

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Aim: To investigate the factors related to the effect of eradication therapy with vonoprazan for Helicobacter pylori (H. pylori). Methods: We retrospectively reviewed medical records of H. pylori-positive patients who received first-line (40 mg vonoprazan/60 mg lansoprazole or 20 mg rabeprazole, 1500 mg amoxicillin, 400 mg clarithromycin, all 2/day for 7 days) (n = 4118). H. pylori eradication was assessed by the 13 C-urea breath test with success defined as a result of < 2.5‰. Using propensity score matching, successful eradication rates were compared between two groups: those receiving vonoprazan and those receiving a proton pump inhibitor. Related factors and adverse events were investigated. Results: Successful first-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.8% and 91.4% for VPZ therapy. Eradication rates using propensity matched patients (n = 1053) who received first-line vonoprazan therapy were higher than in those using proton pump inhibitor (PPI) therapy (92.1% vs. 79.7% in per-protocol analysis, p < 0.0001). Multivariate analysis confirmed that gastric mucosal atrophy was associated with treatment success. Conclusions: Low-dose clarithromycin triple therapy for first-line H. pylori eradication therapy using vonoprazan was more effective than standard triple therapy with proton pump inhibitor. Gastric mucosal atrophy was associated with treatment success.

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Evidence that the Degree and Duration of Acid Suppression are Related to Helicobacter pylori Eradication by Triple Therapy

Abstract: The sustained intragastric pH > 4.0 for a longer postdose time appears to be required for a successful eradication of H. pylori with lansoprazole and acid-labile antibiotics.

Cited by 137 publications

References 32 publications

Elevated Serum anti-Helicobacter pylori IgG Levels is a Predictor of Successful Eradication Therapy

Elevated Serum anti-Helicobacter pylori IgG Levels is a Predictor of Successful Eradication Therapy

A Multicenter Prospective Observational Study of Triple Therapy with Rabeprazole, Amoxicillin and Metronidazole for <i>Helicobacter pylori</i> in Japan

Gastric Mucosal Atrophy Might Be Associated with the Efficacy of First-Line Therapy Using Vonoprazan for <i>Helicobacter pylori</i>

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Evidence that the Degree and Duration of Acid Suppression are Related to Helicobacter pylori Eradication by Triple Therapy

Abstract: The sustained intragastric pH > 4.0 for a longer postdose time appears to be required for a successful eradication of H. pylori with lansoprazole and acid-labile antibiotics.

Cited by 137 publications

References 32 publications

Elevated Serum anti-Helicobacter pylori IgG Levels is a Predictor of Successful Eradication Therapy

Elevated Serum anti-Helicobacter pylori IgG Levels is a Predictor of Successful Eradication Therapy

A Multicenter Prospective Observational Study of Triple Therapy with Rabeprazole, Amoxicillin and Metronidazole for <i>Helicobacter pylori</i> in Japan

Gastric Mucosal Atrophy Might Be Associated with the Efficacy of First-Line Therapy Using Vonoprazan for &lt;i&gt;Helicobacter pylori&lt;/i&gt;

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Gastric Mucosal Atrophy Might Be Associated with the Efficacy of First-Line Therapy Using Vonoprazan for <i>Helicobacter pylori</i>