Evaluation of the efficacy of two different Helicobacter pylori eradication regimens at a secondary public health care center

Öz

Objective: Helicobacter pylori (H. pylori) is a bacterium that infects more than half of the world's population and is defined as a class 1 carcinogen by the World Health Organization. The aim of this study is to compare the efficacy of treatments in patients with H. pylori positivity who were treated with a modified sequential treatment regimen containing levofloxacin or a bismuth-based quadruple treatment regimen in a secondary state hospital. Method: This study includes retrospective analysis of 167 patients who received and tolerated H. pylori eradication therapy between April 2021 and April 2022. The patients included in the study were divided into two groups according to the treatment regimen they received. Patients given a modified sequential treatment regimen containing levofloxacin (amoxicillin 1 g 2x1, pantoprazole 40 mg 2x1 for 7 days, followed by pantoprazole 40 mg 2x1 for 7 days, metronidazole 500 mg 3x1, levofloxacin 500 mg 1x1) Group 1 and the patients who were given bismuth-based quadruple therapy (14 days pantoprazole 40 mg 2x1, bismuth subsalicylate 262 mg 2x2, metronidazole 500 mg 3x1 and tetracycline 500 mg 4x1) were determined as Group 2. Results: A total of 14 patients (one in group 1 and 13 in group 2) could not tolerate H.pylori treatment, and eradication was achieved in 83 (90.2%) in group 1 and 70 (93.3%) in group 2 of 167 patients who completed the treatment. There was no statistically significant difference in eradication success rates in both treatment protocols (p=.470). There was no significant difference between the treatment groups in terms of age, gender, indications for endoscopy, endoscopic diagnoses, pathological findings, and eradication indications. Conclusion: Considering the eradication success rates found in our study, it supports that the modified sequential treatment regimen containing levofloxacin may be an alternative to bismuth-based treatment in the first-line treatment in our country, or a second-line treatment in patients who cannot tolerate bismuth-based treatment. However, further studies on modified sequential therapy containing levofloxacin are needed.

Anahtar Kelimeler

• Bismuth
• eradication
• Helicobacter pylori
• levofloxacin

İKİNCİ BASAMAK DEVLET HASTANESİNDE İKİ FARKLI HELICOBACTER PYLORI TEDAVİ REJİMİNİN ETKİNLİĞİNİN DEĞERLENDİRİLMESİ.

Öz

Öz (tr) Amaç: Helicobakter pylori (H. pylori); dünya nüfusunun yarısından fazlasını enfekte eden ve Dünya Sağlık Örgütü tarafından sınıf 1 kanserojen olarak tanımlanan bir bakteridir. Bu çalışmada amaç ikinci basamak devlet hastanesinde, H. pylori pozitifliği saptanan ve levofloksasin içeren modifiye sıralı tedavi rejimi veya bizmut bazlı dörtlü tedavi rejimi uygulanan hastalarda tedavilerin etkinliğinin karşılaştırılmasıdır. Yöntem: Bu çalışma, Nisan 2021 ile Nisan 2022 tarihleri arasında H. pylori eradikasyon tedavisi verilip, bu tedaviyi tolere eden 167 hastanın retrospektif analizini içermektedir. Çalışmaya dahil edilen hastalar aldıkları tedavi rejimine göre iki gruba ayrıldı. Levofloksasin içeren modifiye sıralı tedavi rejimi (7 gün amoksisilin 1 gr 2x1, pantoprazol 40 mg 2x1, ardından 7 gün pantoprazol 40 mg 2x1, metronidazol 500 mg 3x1, levofloksasin 500 mg 1x1) verilen hastalar Grup 1, bizmut bazlı dörtlü tedavi (14 gün pantoprazol 40 mg 2x1, bizmut subsalisilat 262 mg 2x2, metronidazol 500 mg 3x1, tetrasiklin 500 mg 4x1) verilen hastalar Grup 2 olarak belirlendi. Bulgular: H. pylori tedavisini toplam 14 (grup 1’de bir ve grup 2’de 13) hasta tolere edemedi, tedaviyi tamamlayan toplam 167 hastanın, grup 1’de 83 (%90,2)'ünde, grup 2’de 70 (%93,3)'inde eradikasyon sağlandı. Her iki tedavi protokolünde de eradikasyon başarı oranları açısından istatistiksel anlamlı farklılık saptanmadı (p=,470). Tedavi grupları arasında yaş, cinsiyet, endoskopi endikasyonu, endoskopik tanılar, patolojik bulgular, eradikasyon endikasyonları açısından anlamlı farklılık yoktu. Sonuç: Çalışmamızda saptanan eradikasyon başarı oranları dikkate alındığında, levofloksasin içeren modifiye sıralı tedavi rejiminin, ülkemizde birinci basamak tedavide bizmut bazlı tedaviye alternatif veya bizmut bazlı tedaviyi tolere edemeyen hastalarda ikinci sıra tedavi olabileceğini desteklemektedir. Yine de, levofloksasin içeren modifiye sıralı tedavi ile ilgili daha fazla çalışmaya ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Bizmut
• eradikasyon
• Helicobakter pylori
• levofloksasin

Kaynakça

1. 1. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1:1311-5.
2. 2. Lawson AJ. Helicobacter. In: Jorgensen JH, Landry ML, Warnock DW, eds. Manual of Clinical Microbiology. Washington DC: ASM Press; 2011:900-15.
3. 3. Goh KL, Chan WK, Shiota S, Yamaoka Y. Epidemiology of Helicobacter pylori infection and public health implications. Helicobacter. 2011;16Suppl 1(01):1–9.
4. 4. Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori infection. Helicobacter. 2014;19 Suppl 1:1–5
5. 5.Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev. 2000;22(3):283-97
6. 6. Craanen ME, Dekker W, Blok P, Ferwerda J, Tytgat GN. Intestinal metaplasia and Helicobacter pylori: an endoscopic bioptic study of the gastric antrum. Gut. 1992;33:16-20.
7. 7.Weck MN, Brenner H. Association of Helicobacter pylori infection with chronic atrophic gastritis: Meta-analyses according to type of disease definition. Int J Cancer. 2008;123:874-81.
8. 8. Megraud F, Lehours P. Helicobacter pylori detection and antibiotic susceptibility testing. Clin Microbiol Rev. 2007;20(2):280-322.

9. 9. Shimoyama T. Stool antigen tests for the management of Helicobacter pylori infection. World J Gastroenterol. 2013;19(45):8188-91.
10. 10. Tomita T, Fukuda Y, Tamura K, et al. Successful eradication of Helicobacter pylori prevents relapse of peptic ulcer disease. Aliment Pharmacol Ther. 2002;16 (Suppl 2):204-9.
11. 11.Zullo A, Hassan C, Cristofari F, Perri F, Morini S. Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond. World J Gastrointest Oncol. 2010;2(2):181-6.
12. 12. Bazzoli F, Bianchi Porro G, Bianchi MG, Molteni M, Pazzato P, Zagari RM. Treatment of Helicobacter pylori infection. Indications and regimens: an update. Dig Liver Dis. 2002 Jan;34(1):70-83.
13. 13. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017;112(2):212–38.
14. 14.Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6-30.
15. 15. Dunn BE, Cohen H, Blaser MJ. Helicobacter pylori. Clin Microbiol Rev. 1997;10(4):720-41.
16. 16. Gatta L, Vakil N, Vaira D, Scarpignato C. Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy. BMJ. 2013;347:f4587.
17. 17.Li B-Z, Threapleton DE, Wang J-Y, et al. Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis. BMJ. 2015;351:h4052.
18. 18. Liou J-M, Chen C-C, Fang Y-J, et al. 14-day sequential therapy versus 10-day bismuth quadruple therapy containing high-dose esomeprazole in the first-line and second-line treatment of Helicobacter pylori: a multicentre, non-inferiority, randomized trial. J Antimicrob Chemother. 2018;73(9):2510-8.
19. 19. Tsay F-W, Wu D-C, Yu H-C, et al. Both 14-day hybrid and bismuth quadruple therapies cure most patients with Helicobacter pylori infection in populations with moderate antibiotic resistance: a randomized controlled trial. Antimicrob Agents Chemother. 2017;61(11):e00140-17.
20. 20. Salazar CO, Cardenas VM, Reddy RK, Dominguez DC, Snyder LK, Graham DY. Greater than 95% success with 14-day bismuth quadruple anti- Helicobacter pylori therapy: a pilot study in US Hispanics. Helicobacter. 2012;17(5):382-90.
21. 21. Seo SI, Lim H, Bang CS, et al. Bismuth-based quadruple therapy versus metronidazole-intensified triple therapy as a first-line treatment for clarithromycin-resistant Helicobacter pylori Infection: A multicenter randomized controlled trial. Gut Liver. 2022;16(5):697-705.
22. 22. Nazım EK, Berat EB, Bacaksız F. Evaluation of the efficacy of three different treatment regimens in patients receiving Helicobacter Pylori first-line treatment. Journal of Harran University Medical Faculty. 2021;18(1):100-3.
23. 23. Aydemir S, Bayraktaroğlu T, Üstündağ Y, et al. The efficacy of quadruple therapy consisting of lansoprazole, ranitidine bismuth citrate, tetracycline and metronidazole in Helicobacter pylori infection not eradicated with standard triple therapy. Journal of Academic Gastroenterology. 2004;3(3):129-33.
24. 24. Uygun A, Kadayifci A, Safali M, Ilgan S, Bagci S. The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori. J Dig Dis. 2007;8(4):211-5.
25. 25. Özden A, Seven G, Bektaş M. Effectiveness of different treatment regimens in helicobacter pylori eradication: Tenyear experience of a single institution. Turk J Gastroenterol. 2010;21(3):218–23.
26. 26. Chuah SK, Liang CM, Lee CH, et al. A randomized control trial comparing 2 levofloxacin-containing second-line therapies for Helicobacter pylori eradication. Medicine (Baltimore). 2016;95(19):e3586.
27. 27. Sherkatolabbasieh H, Shafizadeh S, Azadbakht S, et al. Levofloxacin-based sequential therapy versus classic triple therapy in Helicobacter pylori eradication: A randomized clinical trial. Biomedical Research and Therapy. 2017;4(11):1785-94.
28. 28. Romano M, Cuomo A, Gravina AG, et al. Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomized trial. Gut. 2010;59:1465–70.
29. 29. Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, et al. Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2010;31:1077–84.
30. 30. Aydin A, Oruc N, Turan I, Ozutemiz O, Tuncyurek M, Musoglu A. The modified sequential treatment regimen containing levofloxacin for Helicobacter pylori eradication in Turkey. Helicobacter. 2009;14(6):520-4.
31. 31. Ozdil K, Calhan T, Sahin A, et al. Levofloxacin based sequential and triple therapy compared with standard plus probiotic combination for Helicobacter pylori eradication. Hepatogastroenterology. 2011;58(109):1148-52.
32. 32. Polat Z, Kadayifci A, Kantarcioglu M, Ozcan A, Emer O, Uygun A. Comparison of levofloxacin-containing sequential and standard triple therapies for the eradication of Helicobacter pylori. Eur J Intern Med. 2012;23(2):165-8.
33. 33. Nyssen OP, Perez-Aisa A, Tepes B, et al; Hp-EuReg Investigators. adverse event profile during the treatment of Helicobacter pylori: a real-world experience of 22,000 patients from the European Registry on H. pylori management (Hp-EuReg). Am J Gastroenterol. 2021;116(6):1220-9.
34. 34. Losurdo G, Cubisino R, Barone M, et al. Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis. World J Gastroenterol. 2018;24(1):139-49.
35. 35. Chung JW, Lee JH, Jung HY, et al. Second-line Helicobacter pylori eradication: a randomized comparison of 1-week or 2-week bismuth-containing quadruple therapy. Helicobacter. 2011;16(4):289-94.