Background and Aims: Currently, Helicobacter pylori cannot be eradicated in 100% of patients. In this study, we aimed to evaluate the efficacy of vitamin C and E supplementation on the Helicobacter pylori eradication rate with a levofloxacin-based regimen. Materials and Methods: Seventy patients with Helicobacter pylori -positive nonulcer dyspepsia were randomized into two groups. In group A, patients received lansoprazole 30 mg BID, amoxicillin 1000 mg BID, and levofloxacin 500 mg BID for 14 days; in group B, patients received lansoprazole 30 mg BID, amoxicillin 1000 mg BID, and levofloxacin 500 mg BID for 14 days in combination with vitamin C 500 mg BID and vitamin E 200 IU BID for 30 days. Helicobacter pylori eradication was evaluated with C14 urea breath test 4-6 weeks after the completion of therapy. Results: All patients in both groups completed the therapy. Helicobacter pylori eradication was achieved in 23 of 35 patients (65.8%) in group A and 27 of 35 (77.2%) in group B. The difference was not statistically significant (p=0.404). Conclusions: Helicobacter pylori eradication rates of both regimens were superior to that of standard triple therapy. The eradication rate of levofloxacin-based regimen plus vitamins C and E was close to the acceptable 80% eradication rate. The results of the present study revealed that adjuvant therapies such as vitamins C and E should be added to the eradication regimens.
Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection. The Maas- tricht-III 2007 Consensus Report. Gut 2007;56:772-81.
Sezikli M, Çetinkaya ZA, Güzelbulut F, et al. Supplementing vita- mins C and E to standard triple therapy for the eradication of He- licobacter pylori. J Clin Pharm Ther 2012;37:282-5.
Sezikli M, Cetinkaya ZA, Güzelbulut F, et al. Efficacy of vitamins supplementation to therapy on Helicobacter pylori eradication in patients with low antioxidant capacity. Clin Res Hepatol Gastroen- terol 2011;35:745-9.
Kadayifci A, Buyukhatipoglu H, Cemil Savas M, Simsek I. Eradicati- on of Helicobacter pylori with triple therapy: an epidemiologic analysis of trends in Turkey over 10 years. Clin Ther 2006;28:1960- 6.
Göral V, Zeyrek FY, Gül K. Helikobakter pilori enfeksiyonunda anti- biyotik direnci. T Klin Gastroenterohepatol Derg 2000;11:87-92.
Siavoshi F, Saniee P, Latifi-Navid S, et al. Increase in resistance ra- tes of H. pylori isolates to metronidazole and tetracycline--compa- rison of three 3-year studies. Arch Iran Med 2010;13:177-87.
Saracino IM, Zullo A, Holton J, et al. High prevalence of primary antibiotic resistance in Helicobacter pylori isolates in Italy J. Gas- trointestin Liver Dis 2012;21:363-5.
Cağdaş U, Otağ F, Tezcan S, et al. Detection of Helicobacter pylo- ri and antimicrobial resistance in gastric biopsy specimens. Mikro- biyol Bul 2012;46:398-409.
B.Yasar,E. Abut,H. Kayadibi, et al. Efficacy of probiotics in Helico- bacter pylori eradication therapy. Turk J Gastroenterol 2010;21: 212-7.
Sezikli M, Cetinkaya ZA, Sezikli H, et al. Oxidative stress in Helico- bacter pylori infection: does supplementation with vitamins C and E increase the eradication rate? Helicobacter 2009;14:280-5.
Zojaji H, Talaie R, Mirsattari D, et al. The efficacy of Helicobacter pylori eradication regimen with and without vitamin C supplemen- tation. Dig Liver Dis 2009;41:644-7.
Kaboli SA, Zojaji H, Mirsattari D, et al. Effect of addition of vita- min C to clarithromycin- amoxicillin-omeprazol triple regimen on Helicobacter pylori eradication. Acta Gastroenterol Belg 2009;72: 222-4.
Halliwell B, Gutteridge JM. Lipid peroxidation, oxygen radicals, cell damage, and antioxidant therapy. Lancet 1984;1:1396-7.
Halliwell B, Gutteridge JM eds. Free Radicals in Biology and Medi- cine, 3rdedn. Oxford, UK: Oxford Science Publications, 2000.
Naito Y, Yoshikawa T. Molecular and cellular mechanisms involved in Helicobacter pylori-induced inflammation and oxidative stress. Free Radic Biol Med 2002;33:323-36.
Sezikli M, Çetinkaya ZA, Güzelbulut F, et al. Supplementing vita- mins C and E to standard triple therapy for the eradication of He- licobacter pylori. J Clin Pharm Ther 2012;37:282-5.
Güliter S, Keleş H, Ozkurt ZN, et al. Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of helicobacter pylori? Turk J Gastroenterol 2005; 16:29-33.
Hung KH, Sheu BS, Chang WL, et al. Prevalence of primary fluoro- quinolone resistance among clinical isolates of Helicobacter pylori at a University Hospital in Southern Taiwan. Helicobacter 2009;14: 61-5.
Bogaerts P, Berhin C, Nizet H, et al. Prevalence and mechanisms of resistance to fluoroquinolones in Helicobacter pylori strains from patients living in Belgium. Helicobacter 2006;11:441-5.
Yu C, Li L, Chen W, et al. Levofloxacin susceptibility testing for He- licobacter pylori in China: comparison of E-test and disk diffusion method. Helicobacter 2011;16:119-23.
Erdoğan AF, Abacı K, Serin E, et al. Birinci tercih Helikobakter pilo- ri eradikasyon tedavileri alarm mı veriyor? Akademik Gastroenterol Dergisi 2009;8:59-62.
Aydın Y, Nazlıgül Y, Yeniova AÖ, et al. The efficacy of levofloxacin- based triple therapy for first-line Helicobacter pylori eradication Dicle Med J 2011;38:197-201.
Li G, Li L, Yu C, Chen L. Effect of vitamins C and E supplementati- on on Helicobacter pylori eradication: a meta-analysis. Br J Nutr 2011;106:1632-7.
Güzelbulut F, Sezikli M, Cetinkaya ZA, et al. 7 günlük standard üç- lü tedaviye C ve E vitamini eklenmesi Helikobakter pilori eradikas- yon oranını arttırır. Akademik Gastroenteroloji Dergisi 2010;9:60- 3.
Helikobakter pilori eradikasyonunda levofloksasin bazl› rejime C ve E vitamini eklemenin eradikasyon üzerine etkileri
Giriş ve Amaç: Günümüzde Helikobakter pilori hastaların %100'ünde eradike edilememektedir. Bu çalışmanın amacı levoşoksasin bazlı tedaviye vitamin C ve E eklemenin Helikobakter pilori eradikasyon oranları üzerine etkisini araştırmaktır. Gereç ve Yöntem: Helikobakter pilori pozitif nonülser dispepsili 70 hasta 2 gruba randomize edildi. Grup A'daki hastalara 14 günlük lansoprazol 30 mg 2x1, amoksisilin 1000 mg 2x1 ve levoşoksasin 500 mg 1x1; grup B'deki hastalara 14 günlük lansoprazol 30 mg 2x1, amoksisilin 1000 mg 2x1 ve levoşoksasin 500 mg 1x1 ile birlikte 30 günlük vitamin C 500 mg 2x1 ve vitamin E 200 IU 2x1 verildi. Helikobakter pilori eradikasyonu tedavi bitiminden 4-6 hafta sonra C14 üre nefes testi ile de¤erlendirildi. Bulgular: Her 2 grupta da tüm hastalar tedaviyi tamamladı. Grup A'daki 35 hastanın 23'ünde (%65.8), grup B'deki 35 hastanın 27'sinde (%77.2) Helikobakter pilori eradikasyonu elde edildi. 2 grup arasındaki fark istatistiksel olarak anlamlı de¤ildi (p=0.404). Sonuç: Her 2 rejim ile elde edilen Helikobakter pilori eradikasyon oranları literatürde bildirilen oranlardan daha yüksektir. Levoşoksasin bazlı tedavi ile birlikte vitamin C ve E verilmesi ile elde edilen eradikasyon oranı kabul edilebilir %80'lik orana yakı ndı. Bu çalışmanın sonucu eradikasyon rejimlerine vitamin C ve E gibi ajanların eklenmesi eradikasyon oranlarını artırabilir.
Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection. The Maas- tricht-III 2007 Consensus Report. Gut 2007;56:772-81.
Sezikli M, Çetinkaya ZA, Güzelbulut F, et al. Supplementing vita- mins C and E to standard triple therapy for the eradication of He- licobacter pylori. J Clin Pharm Ther 2012;37:282-5.
Sezikli M, Cetinkaya ZA, Güzelbulut F, et al. Efficacy of vitamins supplementation to therapy on Helicobacter pylori eradication in patients with low antioxidant capacity. Clin Res Hepatol Gastroen- terol 2011;35:745-9.
Kadayifci A, Buyukhatipoglu H, Cemil Savas M, Simsek I. Eradicati- on of Helicobacter pylori with triple therapy: an epidemiologic analysis of trends in Turkey over 10 years. Clin Ther 2006;28:1960- 6.
Göral V, Zeyrek FY, Gül K. Helikobakter pilori enfeksiyonunda anti- biyotik direnci. T Klin Gastroenterohepatol Derg 2000;11:87-92.
Siavoshi F, Saniee P, Latifi-Navid S, et al. Increase in resistance ra- tes of H. pylori isolates to metronidazole and tetracycline--compa- rison of three 3-year studies. Arch Iran Med 2010;13:177-87.
Saracino IM, Zullo A, Holton J, et al. High prevalence of primary antibiotic resistance in Helicobacter pylori isolates in Italy J. Gas- trointestin Liver Dis 2012;21:363-5.
Cağdaş U, Otağ F, Tezcan S, et al. Detection of Helicobacter pylo- ri and antimicrobial resistance in gastric biopsy specimens. Mikro- biyol Bul 2012;46:398-409.
B.Yasar,E. Abut,H. Kayadibi, et al. Efficacy of probiotics in Helico- bacter pylori eradication therapy. Turk J Gastroenterol 2010;21: 212-7.
Sezikli M, Cetinkaya ZA, Sezikli H, et al. Oxidative stress in Helico- bacter pylori infection: does supplementation with vitamins C and E increase the eradication rate? Helicobacter 2009;14:280-5.
Zojaji H, Talaie R, Mirsattari D, et al. The efficacy of Helicobacter pylori eradication regimen with and without vitamin C supplemen- tation. Dig Liver Dis 2009;41:644-7.
Kaboli SA, Zojaji H, Mirsattari D, et al. Effect of addition of vita- min C to clarithromycin- amoxicillin-omeprazol triple regimen on Helicobacter pylori eradication. Acta Gastroenterol Belg 2009;72: 222-4.
Halliwell B, Gutteridge JM. Lipid peroxidation, oxygen radicals, cell damage, and antioxidant therapy. Lancet 1984;1:1396-7.
Halliwell B, Gutteridge JM eds. Free Radicals in Biology and Medi- cine, 3rdedn. Oxford, UK: Oxford Science Publications, 2000.
Naito Y, Yoshikawa T. Molecular and cellular mechanisms involved in Helicobacter pylori-induced inflammation and oxidative stress. Free Radic Biol Med 2002;33:323-36.
Sezikli M, Çetinkaya ZA, Güzelbulut F, et al. Supplementing vita- mins C and E to standard triple therapy for the eradication of He- licobacter pylori. J Clin Pharm Ther 2012;37:282-5.
Güliter S, Keleş H, Ozkurt ZN, et al. Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of helicobacter pylori? Turk J Gastroenterol 2005; 16:29-33.
Hung KH, Sheu BS, Chang WL, et al. Prevalence of primary fluoro- quinolone resistance among clinical isolates of Helicobacter pylori at a University Hospital in Southern Taiwan. Helicobacter 2009;14: 61-5.
Bogaerts P, Berhin C, Nizet H, et al. Prevalence and mechanisms of resistance to fluoroquinolones in Helicobacter pylori strains from patients living in Belgium. Helicobacter 2006;11:441-5.
Yu C, Li L, Chen W, et al. Levofloxacin susceptibility testing for He- licobacter pylori in China: comparison of E-test and disk diffusion method. Helicobacter 2011;16:119-23.
Erdoğan AF, Abacı K, Serin E, et al. Birinci tercih Helikobakter pilo- ri eradikasyon tedavileri alarm mı veriyor? Akademik Gastroenterol Dergisi 2009;8:59-62.
Aydın Y, Nazlıgül Y, Yeniova AÖ, et al. The efficacy of levofloxacin- based triple therapy for first-line Helicobacter pylori eradication Dicle Med J 2011;38:197-201.
Li G, Li L, Yu C, Chen L. Effect of vitamins C and E supplementati- on on Helicobacter pylori eradication: a meta-analysis. Br J Nutr 2011;106:1632-7.
Güzelbulut F, Sezikli M, Cetinkaya ZA, et al. 7 günlük standard üç- lü tedaviye C ve E vitamini eklenmesi Helikobakter pilori eradikas- yon oranını arttırır. Akademik Gastroenteroloji Dergisi 2010;9:60- 3.
Sezikli, M., Çetinkaya, Z. A., Şirin, G., Güzelbulut, F. (2012). Helikobakter pilori eradikasyonunda levofloksasin bazl› rejime C ve E vitamini eklemenin eradikasyon üzerine etkileri. Akademik Gastroenteroloji Dergisi, 11(3), 117-120.