Seven-day proton pump inhibitor, amoxicillin and clarithromycin triple therapy. factors that influence Helicobacter pylori eradications success

AIM

To evaluate which factors influence eradication success with standard triple therapy for Helicobacter pylori.

PATIENTS AND METHODS

A prospective study was made of 891 patients infected by H. pylori and diagnosed with duodenal ulcer (n=422), gastric ulcer (n=221), or functional dyspepsia (n=248). Initially, an endoscopy with biopsies of antrum and body (haematoxylin-eosin stain), and a 13C-urea breath test were performed. All patients were treated for seven days with either omeprazole 20 mg twice daily in 442 patients (OCA) or pantoprazole 40 mg twice daily in 449 patients (PCA), associated to clarithromycin (500 mg twice a day) and amoxicillin (1 g twice a day). Two months after completing therapy urea breath test was repeated to confirm eradication.

RESULTS

Mean age +/- SD was 51.6 +/- 15 years, 61% were male. Overall eradication rate was 73.7% (95% CI 69-77%) and 80.8% (77-84%) with OCA and PCA therapy, respectively, showing significant difference between treatment regimens (chi 2 =6.3; p= 0.01). As refers to underlying diseases, H. pylori eradication was achieved in 77.4% (74-80%) of peptic ulcers and 77% (71-82%) of functional dyspepsia (p=n.s.). With our two treatment regimens (OCA/PCA) eradication success was 74/81% in peptic ulcer (p=0.03), and 72/80% in functional dyspepsia (p=0.1). In the multivariate analysis, type of therapy was the only variable that correlated with eradication success (odds ratio 1.5; 95% CI: 1.1-2.1) (chi2 model: 6,4; p=0.01).

CONCLUSIONS

Standard triple therapy containing a proton pump inhibitor, clarithromycin and amoxicillin for seven days achieves in our community a moderate eradication success; this result could improve by using pantoprazole instead of omeprazole. This therapy is equally effective in patients with peptic ulcer and functional dyspepsia.

[Course of histological lesions of the gastric mucosa after eradication of H. pylori in patients with duodenal ulcer. Initial study and 6-month follow-up]

Helicobacter pylori is the major etiologic agent of chronic active gastritis, and it may be isolated from the gastric mucosa in a high proportion of patients with duodenal ulcer.

AIM

To study, in duodenal ulcer patients, the histological changes associated with H. pylori infection in gastric antrum and body, and the improvement of such lesions after eradication, at an early stage and after 6 months.

METHODS

76 patients with duodenal ulcer disease were investigated prospectively. Biopsy specimens taken by endoscopy from the duodenal bulb, antrum, body and gastric fundus were analyzed by microbiological and histological methods. A patient was considered to be H. pylori-positive when microbiology or/and histology demonstrated colonization in any of the locations. An endoscopy with biopsy samples from the antrum and gastric body was performed 1 month after therapy and 4 months later. Different therapy regimens were used: amoxicillin/clavulanic plus omeprazole or ranitidine; triple therapy; and omeprazole or ranitidine alone.

RESULTS

All patients were positive by microbiology. Eradication was reached as a whole in 47% (N = 36). In those patients, in gastric antrum, rates of chronic gastritis/chronic active gastritis previous to treatment and 2 and 6 months later were 100%/96%; 38%/23% and 16%/5.6% respectively. At gastric body they were: 54%/38%; 12%/12% and 12%/5.6% respectively. A favourable histologic evolution, globally and of the acute inflammatory component, was observed 1 month after therapy (p < 0.001). Six months later, there was further improvement which did not reach a statistically significant difference compared with the results obtained at the first month. No differences were observed when eradication failed.

CONCLUSION

An improvement of antral and gastric body gastritis is associated with H. pylori eradication in duodenal ulcer patients. This successful evolution is observed immediately after eradication, and it is confirmed six months after the diagnosis.

Bridging hepatic necrosis associated with cimetidine

A patient who presented with reflux esophagitis developed hepatitis attributed to cimetidine. Pathologic study of the liver revealed bridging hepatic necrosis. This finding has not been described before.