Five-day Triple Therapy in Helicobacter pylori-positive Duodenal Ulcer

Abstract

The aim of this study was to compare the efficacy of two different 5-day proton pump inhibitor (PPI)-based triple therapies for Helicobacter pylori (Hp)-positive duodenal ulcers (DUs). Eighty-four patients received pantoprazole (Pan) 80 mg O.D. (once daily) for 1 week; 88 patients received omeprazole (Ome) 40 mg O.D. for 1 week. Patients of both groups received clarithromycin (Cla) 500 mg B.I.D. (twice daily) and amoxicillin (Amo) 1 g B.I.D. for 5 days. All of them were clinically and endoscopically investigated before enrollment (T0) and at 1 (T1), 6 (T2), 12 (T3), and 18 months (T4) after the end of the therapy. Hp status was determined by rapid urease test and by histology. At T1, we observed ulcer healing in 87.5% of the patients and Hp eradication in 83.7% of the Pan group (per protocol [PP]). In the Ome group, ulcer healing was noticed in 95.1% and Hp eradication in 95.1% (PP). We found no statistical differences between the groups (PP). At the end of the follow-up, we found a healing rate of 100% both in the Pan group and in the Ome group; an eradication rate of 98.4% and 100% was observed in the Pan group and in the Ome group, respectively. We found no statistical differences between the groups (PP). Hp eradication was associated with an improvement in the grade of gastritis at T1, remaining unchanged until T4. In conclusion, the efficacy of the Pan treatment was similar to the Ome treatment.

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

“…In our previous H. pylori eradication trials, we have demonstrated that double doses of PPIs were effective in inducing H. pylori -positive duodenal ulcer, while rabeprazole has shown to be efficacious in single dose (20 mg daily) as well as in double dose (40 mg daily), achieving an eradication and a healing rate as satisfactory as that of double-dose rabeprazole (40 mg) and omeprazole (40 mg daily) [10, 11, 12]. Several randomised controlled trials have compared short versus longer treatments [5, 29, 30, 31], but among these, only two studies comparing 2/4 days with 7/10 days have shown a significant difference [32, 33, 34].…”

“…Various triple-therapy regimens, consisting in the association of a proton pump inhibitor (PPI) with two antimicrobials (clarithromycin, amoxicillin or metronidazole), have been reported to be effective and a high eradication rate of these different drug combinations have been confirmed in Western countries [5, 6, 7]. More recently, higher doses of PPI, such as lansoprazole- or pantoprazole-based triple therapy, have been shown to be more effective than low doses of PPI in many reports [4, 7, 8, 9, 10, 11, 12]. Rabeprazole, the new member of the class of substituted benzimidazole molecules, is a potent antisecretory agent, suppressing both basal and stimulated gastric acid secretion in a dose-dependent manner [13, 14, 15].…”

Potent Gastric Acid Inhibition in Helicobacter pylori Eradication

“…[87] The major result of the aforementioned metaanalysis comparing pantoprazole with other PPIs (such as omeprazole or lansoprazole) as eradication therapy against H. pylori is that the results are the same regardless of the PPI used. [78] Thus, as graphically presented in figure 2 derived from the seven studies [88][89][90][91][92][93][94] included in the meta-analysis in which 534 patients received pantoprazole and 603 patients received other PPIs, the mean H. pylori eradication rate was 83% and 81%, respectively. The OR for this comparison was exactly 1 (95% CI, 0.61-1.64).…”

“…Intention-to-treat analysis. [88][89][90][91][92][93][94] OR ¼ odds ratio; 95% CI ¼ 95% confidence interval.…”

<i>Helicobacter pylori</i> Therapy: First-Line Options and Rescue Regimen

“…Randomized clinical trials comparing pantoprazole and omeprazole are summarized in figure 2, where it can be observed that the efficacy of both PPIs are equivalent [8,[11][12][13][14].…”