Factors influencing Helicobacter pylori eradication with 2 week combination therapy of lansoprazole and amoxycillin: Intragastric distribution of colonization and gastric mucosal atrophy

Abstract

In Japan, gastric ulcers are often accompanied by marked gastric mucosal atrophy. We evaluated the dual therapy of double-dose lansoprazole and amoxycillin for Helicobacter pylori eradication in Japanese ulcer patients and investigated the effects of intragastric distribution of H. pylori colonization and gastric mucosal atrophy on eradication with this combination therapy. Seventy-six H. pylori-positive ulcer patients received lansoprazole (30 mg) plus amoxycillin (500 mg) twice daily for 2 weeks (LA-60 group), lansoprazole (30 mg once daily) plus amoxycillin (500 mg twice daily) for 2 weeks (LA-30 group) or lansoprazole (30 mg once daily) for 6 or 8 weeks (LPZ group). Infection was evaluated by light microscopy, culture and biopsy urease tests. Helicobacter pylori colonization was classified as localized to the corpus (localized type) or involving the antrum and corpus (whole type). Fundic mucosal atrophy was graded according to endoscopic and histological features. Eradication was achieved in 67.6% in the LA-60 group, 31.6% in the LA-30 group, and 0% in the LPZ group, and moderate or severe histological gastritis was improved in the LA-60 group. Eradication was better in localized-type colonization (92%) than whole-type (56%), and better with fundic mucosal atrophy (84%) than without, but poor in both whole-type colonization and scanty mucosal atrophy (47%). The LA-60 therapy achieves better eradication in Japanese ulcer patients with localized H. pylori colonization and/or gastric mucosal atrophy, which are likely to be important predictors for the successful eradication with dual therapy.

Quality of RCTs exploringHelicobacter pylorieradication for the prevention of gastric cancer and preneoplastic lesions

“…By screening references listed in the remaining 67 articles and relevant reviews, an additional 12 articles were found. After reviewing the 79 full texts, 20 articles fulfilled the inclusion criteria (Figure 1) [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

“…One reported that atrophy decreased after H. pylori eradication [33]. The other only followed-up for 8 weeks, and did not report the different effects between treatment and control groups [32].…”

“…Characteristics of identified RCTs were shown in Table 1. Half of the trials were performed in Asia, where gastric cancer had the highest incidence rate [18,[20][21][22]25,28,29,32,35,37]. Baseline characteristics of the 8471 participants were various: Special Report only five RCTs recruited healthy H. pylori carriers [18][19][20][21][22], others recruited patients with gastroesophageal reflux disease [23][24][25], or gastritis [26][27][28][29][30][31], or other digestive system diseases.…”

“…Two trials recruited patients with peptic ulcer [32,33]. One reported that atrophy decreased after H. pylori eradication [33].…”

Pooled analysis of Helicobacter pylori eradication regimes in Asia

“…A total of 73 studies (57 papers and 16 abstracts) were included in this systematic overview. 10–82 Of those, 60 were randomized controlled trials. The study design was unclear or unstated in 13 reports.…”