Helicobacter pylori eradication and ulcer healing with daily lansoprazole, plus 1 or 2 weeks co‐therapy with amoxycillin and clarithromycin

Abstract

Background: Proton pump inhibitor based combination therapy is one standard strategy for Helicobacter pylori eradication. Aim: To compare the eradication and duodenal ulcer healing efficacy of two 2‐week, single dose, lansoprazole based combination therapies. Methods: Healthy adult patients with endoscopically confirmed, H. pylori associated duodenal ulcer disease (3 mm > ulcer < 20 mm) were eligible for the study. All patients received a 14 day course of lansoprazole 30 mg o.m., and were randomized to receive either 7 or 14 days of amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. Patients were endoscoped at entry and 14–17 days later. Symptomatic, unhealed patients received a further 14 days of therapy with lansoprazole 30 mg o.m. Eradication was confirmed a minimum of 28 days after cessation of all therapy by urease reaction and histological assessment of gastric body and antral biopsies (three biopsies each site). Results: Sixty‐two patients were randomized to a treatment arm, of which 58 could be included in an intention‐to‐treat and key‐point‐available analysis. H. pylori eradication rates were identical, at 93% (95% CI: 73–98% (1 week), 78–99% (2 week)). In the combined group, all but 13 ulcers were healed at 2 weeks; six required further therapy because of symptoms, while six of the seven asymptomatic patients went on to heal. Conclusion: An eradication regimen, based on a 2‐week course of single dose lansoprazole with 1 week of antibiotic co‐therapy, is effective in eradicating H. pylori, while the 2 weeks of acid suppression is usually effective in duodenal ulcer healing.

A meta‐analysis of short versus long therapy with a proton pump inhibitor, clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection

“…Twenty‐one studies comparing different lengths of proton pump inhibitor and clarithromycin triple therapies were found 4 , . 12 –31 Of these, four studies compared length of therapy other than 7–14 days; 12 , 22 , 24 , 31 in three others, there was no clear statement that randomization was performed 14 , . 19 , 28 Finally, another study was excluded because it used once‐a‐day omeprazole for the triple therapy 29 .…”

“…Many recent studies have compared proton pump inhibitor‐based triple therapies in short (7‐day) and extended (10/14‐day) schedules, and few have found significant differences in eradication rates with longer therapies 4 , . 12 –31 However, most studies have observed a trend towards better results with longer therapies; as the number of patients was reduced, a β‐type error may be present 12 –14 , . 21 , 25 , 28 , 29 , 31 We therefore hypothesized that performing a formal meta‐analysis selecting quality studies would help clarify the question.…”

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

“…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]. However, up to 20% of peptic ulcer treated with the short-term protocol may still be active 1 month after the end of treatment increasing the risk of unhealed ulcers [34, 35].…”

How Can the Current Strategies for Helicobacter pylori Eradication Therapy be Improved?

“…There was a statistically nonsignificant trend for a reduction in H pylori cure for seven-day compared with 10-day therapy (RRR 4%; 95% CI -2% to 10%) ( Figure 6). Twelve trials (43,51,52,(54)(55)(56)(57)(58)(59)(60) evaluating 1592 patients that compared seven-with 14-day PPI triple therapy were also identified. Seven days of therapy was significantly less likely to cure H pylori infection (RRR 12%, 95% CI 7% to 17%; NNT 12, 95% CI 9 to 21) (Figure 7).…”