Sequential treatment for <scp>Helicobacter pylori</scp> does not share the risk factors of triple therapy failure

Francesco, Vincenzo De; Zullo, Angelo; Margiotta, M.; Marangi, Stefania; Burattini, Osvaldo; Berloco, P.B.; Russo, Francesco; Barone, M.; Leo, Alfredo Di; Minenna, M.F.; Stoppino, V.; Morini, Sergio; Pañella, C.; Francavilla, A.; Ierardi, Enzo

doi:10.1046/j.1365-2036.2004.01818.x

Cited by 93 publications

(67 citation statements)

References 27 publications

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“…Some authors found an association between a lower eradication efficacy and H. pylori strains missing the cagA gene or bearing the s2 and m2 vacA alleles, 47,48 whereas other authors did not. 49,50 Our findings did not provide any evidence for an association between eradication failure and cagA or s and m vacA alleles, not between these virulence determinants and 23S rRNA mutations, in agreement with previous data in the literature. 47 Triple therapy combines two antibiotics and a proton pump inhibitor, and these drugs have been demonstrated to synergize in the eradication of the infection.…”

Section: Discussionsupporting

confidence: 92%

Clarithromycin Resistance, Tumor Necrosis Factor Alpha Gene Polymorphism and Mucosal Inflammation Affect H. pylori Eradication Success

Zambon

Fasolo

Basso

et al. 2007

Journal of Gastrointestinal Surgery

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Several bacterial and host-related factors concur in causing Helicobacter pylori eradication failure. We ascertained the role of bacterial virulence genes (cagA, vacA), clarithromycin resistance [Cla(R), 23S ribosomal RNA (rRNA) mutations], host polymorphism of CYP2C19 (polyphosphoinositide, PPI, metabolism) and of the cytokines IL-1B-31C>T, IL-1RN VNTR, IFN-gamma+874A>T, TNF-alpha-1031T>C, TNF-alpha-857C>T, TNF-alpha-376G>A, TNF-alpha-308G>A, TNF-alpha-238G>A, IL-10-1082A>G, IL-10-819C>T, IL-10-592C>A, IL-12A+6686G>A, IL-12B+15485A>C. Two groups of H. pylori-infected and H. pylori-treated patients were retrospectively identified: 45 not eradicated and 57 eradicated. Treatment failure was significantly correlated with Cla(R) (all resistant strains in non-eradicated patients); with TNF-alpha-238, IL10-819, IL10-592, IL-12B+15485 single nucleotide polymorphism (SNP); with IL10 ATA/ATA haplotype; and with antral inflammatory grade. On considering Cla(S)-infected patients only, logistic regression analysis (eradication = dependent; TNF-alpha-238, IL12B + 15485 genotypes, IL10 ATA/ATA as present or absent, antral gastritis grade = covariates) confirmed as significantly correlated with eradication antral gastritis grade only (Exp(B) = 6.48; 95% CI, 1.2-35.01). In conclusion, the bacterial determinant causing triple therapy failure is clarithromycin resistant, being virulence genes not involved. The host related factors that favor eradication are those linked to inflammation: a higher inflammatory infiltrate in the mucosa, possibly favored by genotypes able to down regulate the anti-inflammatory cytokine response, enhance the chance of eradication success.

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Section: Discussionsupporting

confidence: 92%

Clarithromycin Resistance, Tumor Necrosis Factor Alpha Gene Polymorphism and Mucosal Inflammation Affect H. pylori Eradication Success

Zambon

Fasolo

Basso

et al. 2007

Journal of Gastrointestinal Surgery

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“…34 Thus, the actual level of exhaled 13C-urea might be dependent on both bacterial urease, carbonic anhydrase, the H. pylori strain, and On the basis of our experience, we suggest that in cases of high pretreatment UBT values (the higher the UBT values, the lower the rate of eradication), the standard therapeutic regimens might be changed: recent therapeutic options include fi rst-line quadruple treatments, novel antibiotics (rifabutin, levofl oxacin, furazolidone), prolongation of treatment duration, increased doses, 35,36 and sequential therapy. 37 The exact UBT cutoff value for accurate prediction of eradication failure must be determined by prospective studies assessing the sensitivity, specifi city, and positive and negative predictive values of the test, and receiveroperating curve characteristics. The design of our study did not allow such calculations.…”

Section: Resultsmentioning

confidence: 99%

Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection

Buzás

Széles

2008

J Gastroenterol

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Serial assessment showed that UBT values after successive treatments showed a marked tendency to increase over time in failed cases. The significance of this phenomenon must be further studied. It might indicate increased colonization, ongoing resistance, or urease gene overexpression. Higher pretreatment UBT values were associated with lower (<60%) eradication rates. In these cases, alternative/rescue therapies should be chosen.

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“…Among the new promising alternatives to triple therapy, a 10-day sequential therapy combining a 5-day course of PPI with amoxicillin immediately followed by a second course of clarithromycin, metronidazole and a PPI for 5 additional days was recently described [58,59,60,61,62]. This treatment seems to be equally effective in patients with ulcer and in those without and achieves excellent cure rates even in patients with clarithromycin resistance [58,59,60].…”

Section: H Pyloritreatment: Recent Developmentsmentioning

confidence: 99%

“…This treatment seems to be equally effective in patients with ulcer and in those without and achieves excellent cure rates even in patients with clarithromycin resistance [58,59,60]. Interestingly, it is the first alternative therapy that has proved superior to triple therapy in a large randomized trial.…”

Section: H Pyloritreatment: Recent Developmentsmentioning

confidence: 99%

<i>Helicobacter pylori</i> Infection: Treatment Options

Calvet

2006

Digestion

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After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy – 7–10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin – followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures. Regrettably, present cure rates for first-line triple therapy are below 80%, and many patients require second-line treatment with further testing and control visits. Although most compliant patients are cured by the second-line treatment, patients often do not complete the full process and, as a result, final cure rates for the whole strategy often fall below 90%. This means that more effective first-line therapies are required. Promising recent developments include using quadruple therapy as first-line therapy, the use of adjuvant lactoferrin with triple therapy and a newly devised combination of a PPI, clarithromycin, amoxicillin and metronidazole, known as sequential treatment. Additional future developments will re quire the incorporation of new antibiotic weapons in the anti-H. pylori arsenal. The new quinolones and rifamycin derivates have recently demonstrated their efficacy in the treatment of H. pylori infection.

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Sequential treatment for Helicobacter pylori does not share the risk factors of triple therapy failure

Cited by 93 publications

References 27 publications

Clarithromycin Resistance, Tumor Necrosis Factor Alpha Gene Polymorphism and Mucosal Inflammation Affect H. pylori Eradication Success

Clarithromycin Resistance, Tumor Necrosis Factor Alpha Gene Polymorphism and Mucosal Inflammation Affect H. pylori Eradication Success

Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection

<i>Helicobacter pylori</i> Infection: Treatment Options

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