Comparison of 10 and 14 days sequential therapy for the eradication of helicobacter pylori

Öz

Background and Aims: The eradication rate of Helicobacter pylori using standard triple therapy (amoxicillin+clarithromycin+proton pump inhibitor) as the first-line therapy has fallen below 50%. This prospective, randomized study was conducted to compare the 5+5 (10)-day and 7+7 (14)-day sequential treatment results in patients with peptic ulcer (gastric ulcer and/or duodenal ulcer) who were identified as histologically positive for Helicobacter pylori infection by gastroscopy. Materials and Methods: This study included 66 patients who had peptic ulcer diagnosed through gastroscopy, had at least two histopatholgically positive results, underwent urea breath test, had positive stool test for Helicobacter pylori antigen, and did not receive eradication therapy before. These patients were randomly divided into two groups and enrolled into the study between March 2014 and August 2015. Group 1 patients (n=33) were administered amoxicillin 1 g+esomeprazole 40 mg 2x1 for the first 5 days, followed by clarithromycin 500 mg+metronidazole 500 mg+esomeprazole 40 mg 2x1 for the next 5 days. Group 2 patients (n=33) were administered amoxicillin 1 g+esomeprazole 40 mg 2x1 for the first 7 days, followed by clarithromycin 500 mg+metronidazole 500 mg+esomeprazole 40 mg 2x1 for the next 7 days. Esomeprazole 40 mg (1x1) treatment was completed during 12 weeks in both groups. After a drug-free period of 15 days, the eradication rate was analyzed by urea breath test and Helicobacter pylori antigen stool test. Results: Ten patients in Group 1 (30.3%) were females, with a meanage of 38.0±13.1 years. Twelve patients in Group 2 (34.4%) were females, with a mean age of 39.0±15.6 years. After treatment, the urea breath test and Helicobacter pylori antigen stool test revealed an eradication rate of 70% in Group 1 and 72.7% in Group 2, with an overall eradication rate of 71.2% in all patients. No significant difference was observed between the two groups. Conclusion: At the end of the consecutive 5+5-day and 7+7-day treatment, an eradication rate of about 70% was achieved in all patients. Although not ideal, this eradication rate implies that the 5+5 (10)-day consecutive treatment could be used an alternative first-line therapy.

Anahtar Kelimeler

• Helicobacter pylori,peptic ulcer,sequential treatment

Helicobacter pylori eradikasyonunda ardışık 5+5 (10) günlük ve ardışık 7+7 (14) günlük tedavilerin karşılaştırılması

Öz

Giriş ve Amaç: 1. basamak Helicobacter pylori tedavisinde klasik 3’lü tedavi amoksisilin+klaritromisin+proton pompa inhibitörü) ile eradikasyon oranları %50’lerin altına düşmüştür. Bu randomize, prospektif çalışmada gastroskopisinde peptik ülser (gastrik ülser ve/veya duodenal ülser) saptanan, histopatolojik olarak Helicobacter pylori pozitif olan hastalarda 5+5 (10) günlük ve 7+7 (14) günlük ardışık tedavi sonuçlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Mart 2014-Ağustos 2015 tarihleri arasında gastroskopide peptik ülser saptanan, histopatoloji, üre-nefes testi veya gaitada Helicobacter pylori antijeni sonuçlarından en az ikisinde pozitiflik tespit edilen ve daha önce eradikasyon tedavisi almamış 66 hasta ardışık olarak 2 gruba randomize edilerek çalışmaya alındı. Grup 1 hastalara (n: 33) 5 gün (amoksisilin 1 gr+esomeprazol 40 mg 2x1) ardından 5 gün (klaritromisin 500 mg+- metronidazol 500 mg+esomeprazol 40 mg 2x1) verildi. Grup 2 hastalara (n: 33) 7 gün (amoksisilin 1 gr+esomeprazol 40 mg 2x1) ardından 7 gün (klaritromisin 500 mg+metronidazol 500 mg+esomeprazol 40 mg 2x1) verildi. Her iki grupta esomeprazol 40 mg (1x1) 12 haftaya tamamlandı. 15 gün ilaçsız dönem sonrası üre-nefes testi ve gaitada Helicobacter pylori antijen testi ile eradikasyon kontrolü yapıldı. Bulgular: Grup 1 hastalarının 10’u (%30.3) kadın, yaş ortalaması 38±13.1 yaş, grup 2 hastalarının 12’si kadın (%34.4), yaş ortalaması 39±15.6 yaş idi. Tedavi sonrası üre-nefes testi ve gaitada Helicobacter pylori antijen testi ile yapılan değerlendirmede grup 1’de eradikasyon oranı %70, grup 2’de %72.7, toplamda %71.2 saptandı. İki grup arasında istatistiksel anlamlı farklılık yoktu. Sonuç: Ardışık 5+5 (10) günlük ve 7+7 (14) günlük tedavi sonucunda benzer şekilde yüzde yetmiş civarında eradikasyon sağlanmıştır. Çok ideal olmamakla birlikte bu eradikasyon oranı 5+5 (10) günlük ardışık tedavinin 1. basamak için alternatif olabileceğini göstermiştir.

Anahtar Kelimeler

• Helicobacter pylori,eradikasyon,ardışık tedavi

Kaynakça

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