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PubMed2006

Eradication rate of Helicobacter pylori according to genotypes of CYP2C19, IL-1B, and TNF-A.

BACKGROUND: Lansoprazole, amoxicillin, and clarithromycin are commonly used drugs for eradication of Helicobacter pylori (H. pylori). A few studies reported that the eradication rate was influenced by the functional polymorphism of CYP2C19, whose product metabolizes proton pomp inhibitors including lansoprazole. METHODS: This study examined the eradication rate among 67 participants in the polymorphism study who visited Daiko Medical Center, Nagoya University from July 2004 to October 2005. The participants aged 20 to 69 years were classified into three group according to CYP2C19 genotype; rapid metabolizers (RM) with *1*1 genotype, intermediate metabolizers (IM) with *1*2 or *1*3 genotype, and poor metabolizers (PM) with *2*2, *2*3, or *3*3 genotype. For the genotype classification, G681A (681G for *1 and 681A for *2) and G636A (636G for *1 and 636A for *3) were genotyped by PCR with confronting two-pair primers (PCR-CTPP). They were also genotyped for IL-1B T-31C and TNF-A T-1031C by a duplex PCR-CTPP. RESULTS: The eradication rate was 70.0% for RM, 93.9% for IM, and 85.7% for PM. The difference in the rate between RM and IM+PM was statistically significant (p=0.025). The eradication rate was highest for those with IL-1B -31CC; the p value was marginal among the whole subjects (chi2=3.78, p=0.05) and not significant among the RM group (chi2=1.60, p=0.21). The genotypes of TNF-A T-1031C had no associations with the eradication rate. But among the RM group, the odd ratio (OR) of the TNF-A CT for the eradication rate relative to TT was marginally reduced (OR=0.05, 95% confidence interval, 0.002-1.19). CONCLUSIONS: The present study confirmed the low eradication rate for RM. The reproduced finding provides evidence that the CYP2C19 genotype is useful to predict the success of the treatment. For the RM group, alternative regimens expected to be with a higher eradication rate will be recommended, especially to those with the TNF-A -1031C allele.

Journal Article↗
PubMed1999

[Investigation about usefulness of serum antibody of Helicobacter pylori and serum pepsinogen I/II ratio as a marker of the judgment after eradication therapy].

To clarify that serum antibody of Helicobacter pylori (H. pylori) and serum pepsinogen I/II ratio are useful or not as a marker of the judgment after eradication therapy, we followed up 84 cases who received eradication therapy comparing with culture and histology (Carnoy's fixation and immunostaining using anti-H. pylori antibody, MIA method). Successful eradication was recognized in 45 of 84 cases (successful group), and remaining 39 cases were unsuccessful (unsuccessful group). Titers of serum H. pylori antibody went down gradually in the successful group, on the other hand, they did not go down constantly and often re-went up in the unsuccessful group. The difference of the various rate of titers in the both groups became clear statistically since 6 months after eradication therapy (p < 0.05). Supposing that cut-off rate of titer was 60% of pre-eradicated titer, sensitivity, specificity, and accuracy were 86.2%, 77.7%, and 84.2%, respectively, at 6 months after eradication therapy. Serum pepsinogen I/II ratio increased regardless of successful or unsuccessful eradication, but the various rate of serum pepsinogen I/II ratio was different in both groups at 1 month and 3 months after eradication therapy (p < 0.05). Serum antibody of H. pylori and serum pepsinogen I/II ratio could be a marker of the judgment after eradication therapy, especially the various rate of serum antibody of H. pylori is useful for the monitor of H. pylori infection in the long term.

Adolescent↗
PubMed1999

[Helicobacter pylori and digestive hemorrhage due to duodenal ulcer: the prevalence of the infection, the efficacy of 3 triple therapies and the role of eradication in preventing a hemorrhagic recurrence].

BACKGROUND: To report the prevalence of Helicobacter pylori in patients with bleeding duodenal ulcer and to verify the effect of eradication on hemorrhage recurrence. To evaluate the efficacy on H. pylori eradication and on ulcer healing of three one-week triple therapies and to compare their efficacy with that of a dual therapy. PATIENTS AND METHODS: One-hundred and eleven patients with bleeding duodenal ulcer not taking gastroerosive drugs were prospectively studied. At endoscopy, biopsies from gastric antrum and body were obtained (haematoxylin-eosin), and a 13C-urea breath test was also performed. Both diagnostic methods were repeated one month after completing one of the following treatments (randomized study): omeprazole (20 mg/12 h), amoxycillin (1 g/12 h) and clarithromycin (500 mg/12 h) (OAC, n = 27); omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and metronidazole (500 mg/12 h) (OCM, n = 27); lansoprazole (30 mg/12 h), amoxycillin (1 g/12 h) and clarithromycin (500 mg/12 h) (LAC, n = 27); and lansoprazole (30 mg/12 h) and clarithromycin (500 mg/8 h) (LC, n = 27). The first three therapies were administered for one week, and LC for two weeks. Once eradication was confirmed no antisecretory therapy was administered. A breath test was performed in the follow-up at 6 months and at one year. RESULTS: The prevalence of H. pylori infection was 97.3% (95% CI: 92-99%). Five patients were lost from the study during follow-up. The eradication efficacy (intention-to-treat) was: OAC, 89% (72-96%); OCM: 93% (77-98%); LAC, 93% (77-98%), and LC, 70% (51-84%). Overall triple therapy efficacy was higher than that of dual therapy (91% vs 70%; p < 0.05). Thirteen patients needed a 2nd or 3rd therapy, and eradication success was finally achieved in all cases. The type of therapy was the only variable which influenced on H. pylori eradication (OR: 4.5; 95% CI: 1.4-14%; p < 0.01) and H. pylori eradication was the only variable which influenced on ulcer healing (OR: 4.7; 95% CI: 1.2-19%; p < 0.05). The yearly reinfection rate was 2.8% (0.9-7.8%). No hemorrhage recurrences occurred during the one year follow-up period. CONCLUSIONS: H. pylori prevalence in bleeding doudenal ulcer is almost 100%. These patients will be spared of hemorrhage recurrence at least for one year if infection is eradicated. Therefore, eradication therapy is the therapy of choice, and maintenance therapy with antisecretory drugs is no longer needed. One-week triple therapies with a proton pump inhibitor and two antibiotics (clarithromycin plus amoxycillin or metronidazole) have a high efficacy in patients with bleeding duodenal ulcer.

Anti-Bacterial Agents↗
PubMed2000

Helicobacter pylori eradication therapy: a discrepancy between current guidelines and clinical practice.

BACKGROUND: Consensus guidelines recommend that patients with peptic ulcer disease, and other causes of dyspepsia, should be treated with Helicobacter pylori eradication regimens. However, it has not been firmly established whether physicians have adapted their practice accordingly. OBJECTIVES: (1) To establish the proportion of ulcer-healing prescriptions that H. pylori eradication regimens accounted for, (2) to evaluate the composition of the eradication regimens used, and (3) to compare the prescribing patterns of specialist and primary care practitioners. METHODS: Seven community pharmacy practices were identified, and all prescriptions for individual acid-suppressing agents and eradication regimens were prospectively evaluated over an initial one-month period. Prospective documentation and evaluation of eradication regimens only was then continued for a further three-month period. RESULTS: The prescriptions for 585 patients were evaluated. Proton-pump inhibitors and H2-receptor antagonists accounted for 261 (44.5%) and 307 (52.5%) of prescriptions respectively. H. pylori eradication therapy was prescribed for 17 (2.9%) patients in this initial period. Sixty-six eradication regimens were evaluated over four months: 48/66 (73%) of these were initiated by primary care practitioners and 18/66 (27%) by specialists. Thirteen different combinations of antibiotics and acid-suppressing agents were identified - many of undocumented efficacy. Dual, triple and quadruple regimens accounted for 15 (23%), 48 (72.5%) and 3 (4.5%) of patient prescriptions respectively. CONCLUSION: H. pylori eradication therapy currently accounts for a very small proportion of ulcer-healing medication in clinical practice. Most eradication regimens are initiated by primary care practitioners. In comparison with specialist practices, prescriptions from this source are more likely to be of undocumented efficacy.

Anti-Bacterial Agents↗
PubMed2000

[Usefulness of Helicobacter pylori antigen detection in stools in the diagnosis of infection and confirming eradication after treatment].

BACKGROUND: A new immunoassay to detect H. pylori antigen in stool (HpSA) has been developed. We started this study to know the sensitivity and specificity of this test as diagnostic tool of H. pylori infection and eradication control. PATIENTS AND METHODS: Forty patients were recruited to study H. pylori infection. At endoscopy, biopsy samples were taken for culture, histology and urease test. Stool specimens were tested by HpSA and serum sample for serology. Patients were defined as H. pylori positive if histology, urease test or culture were positive. Forty-two patients treated with omeprazole based triple therapy were screened 8 weeks after treatment for eradication control using urea breath test, HpSa and serology. Patients with UBT negative were defined as eradicated. RESULTS: As diagnostic tool: 34 out of 40 patients were infected (85%). HpSA was positive in 31 out of 34 patients, and achieve 3 false negative and 1 false positive (sensitivity: 91%, specificity: 84%). IgG anti-H. pylori was positive in 31 out of 34 infected patients, with 3 false positive and 3 false negative (sensitivity 91%, specificity 50%). In eradication control (n = 42), HpSA was negative in 33/38 successfully eradicated patients, and positive in all four non-eradicated patients. Five patients eradicated showed positive HpSA (specificity 87%, positive predictive value: 87%, negative predictive value: 100%). IgG serology was negative in only a third of eradicated patients. CONCLUSIONS: The stool assay was an accurate tool for diagnosis of H. pylori infection and eradication control.

Adult↗
PubMedDate not supplied

Acquisition of Helicobacter pylori infection and reinfection after its eradication are uncommon in Indian adults.

BACKGROUND: Eradication of Helicobacter pylori infection is known to decrease the recurrence rate of peptic ulcer disease. Data from India on the acquisition rate of H. pylori infection and reinfection after eradication are scant. AIM: To study the rates of acquisition of H. pylori infection and of reinfection after eradication in Indian adult patients. METHODS: We evaluated 116 consecutive patients with dyspepsia undergoing endoscopy. Sixty-four of them were H. pylori-positive on gastric antral biopsy (rapid urease test and histology). Patients diagnosed to have H. pylori infection were treated with a four-drug regimen (omeprazole, bismuth subcitrate, tetracycline, furazolidine) for 2 weeks; those failing H. pylori eradication were treated with a second regimen (lansoprazole, amoxycillin, secnidazole) for one week. Patients who were H. pylori-negative to begin with and those who had successful H. pylori eradication were followed up clinically and endoscopically every 3 months for a median of one year. RESULTS: Ninety-six patients (50 H. pylori-positive) were available for study; the other 20 were lost to follow up after the first endoscopy. Fifty of the 96 (52%) were H. pylori-positive; four of these 50 patients did not follow up after first treatment. The eradication rate with the four-drug regimen was 89.1% (41/46). Four of the 5 non-responders eradicated H. pylori with the second regimen. At the end of median one year follow-up (range 9-15 months), one of the 45 patients (2.4%) who eradicated the organism developed reinfection; none of the 46 patients who were initially H. pylori-negative acquired new infection. CONCLUSIONS: The risk of reinfection after eradication is low in Indian subjects at the end of one year. The rate of acquisition of new infection is also low in the adult population.

Adolescent↗
PubMed2001

Helicobacter pylori eradication versus one-year maintenance therapy: effect on relapse and gastritis outcome.

OBJECTIVE: The aim of this study was to determine ulcer healing and H. pylori eradication rates obtained with triple therapy (omeprazole, amoxicillin and clarithromycin). Ulcer relapsing rate one year after eradication was also assessed. Maintenance therapy with placebo was compared with ranitidine therapy and the effect of eradication on histological variables of the gastric mucosa was studied. METHODS: A prospective, double-blind parallel study was performed in 85 patients endoscopically diagnosed of duodenal ulcer H. pylori positive. Patients were randomized to a 7-days triple therapy (group A) or omeprazole plus antibiotic placebo (group B). All patients were treated only with omeprazole for the next three weeks. Patients with ulcer healing after treatment were entered in a one-year follow up phase with ranitidine placebo (group A) or ranitidine (group B). Endoscopy and biopsies were performed at baseline, after treatment (5 weeks) and after 12 months of follow-up or when relapsing symptoms appeared. RESULTS: Healing rate was 90.2% in group A and 85.7% in group B. Eradication rate was 78% in group A and 0% in group B. Out of 37 healed patients in group A, eradication was achieved in 29 and only one relapse was found (3.4%). Three out of eight patients with healing but without eradication relapsed at 12 months (35%) (p < 0.05). Histopathological results showed statistically significant differences (p < 0.05) between eradicated and non eradicated patients in terms of severity of inflammation and intestinal metaplasia, but not in terms of atrophy. CONCLUSIONS: H. pylori eradication is useful to prevent ulcer relapse and to improve gastric mucosa status.

Adolescent↗
PubMed2002

Impact of the recommendations made by Spanish Club for the Study of Helicobacter pylori on eradication indications.

AIM: A Spanish Consensus Conference had been arranged by the Spanish Club for the Study of Helicobacter pylori to encourage the use of eradication regimens in appropriate indications. The aim of our study was to assess whether the publication of these recommendations in November 1999 induced a change on the indications of eradication in the referring primary care district. METHOD: Patients who had undergone Helicobacter pylori eradication therapy indicated by a gastroenterologist and referred to perform the 13C-labelled marked urea breath test were evaluated. Indications of eradication therapy were analysed and divided in: a) use of Conference recommended procedures (duodenal or gastric ulcer, erosive duodenitis, gastric MALT lymphoma and after resection of gastric adenocarcinoma); and b) other procedures not included in the recommendations (the rest). Indications established during former and latter years of publication of the Club's recommendations were compared. RESULTS: A total of 659 established eradications in 1999 against 537 in 2000, were studied. Regarding established eradications in 1999, 418 out of 659 (63%) followed the recommendations made by the Spanish Club, while 241 (37%) did not. In 2000, the proportion of eradication therapy administered using the recommendations made by the Spanish Club was similar to previous year: 338 (63%) followed the recommendations, against 199 (37%) that did not (p = not significant). In both years, considering those indications not recommended, patients either with superficial chronic gastritis with or without dyspepsia or with gastrooesophageal reflux disease were the main disorders to indicate eradication therapy. CONCLUSIONS: The recommendations of the Spanish Helicobacter pylori Study Club have not triggered a significant change after their publication on the indications for Helicobacter pylori eradication therapy in the setting studied.

Adolescent↗
PubMed2004

[Eradication of Helicobacter pylori infection in Europe: a meta-analysis based on congress abstracts, 1997-2002].

BACKGROUND: Meta-analyses evaluated several aspects of Helicobacter pylori eradication based on the randomised controlled trials. AIM: to perform a meta-analysis of the papers presented at the European Helicobacter Pylori Study Group and United European Gastroenterology Week meetings from 1997 to 2002. METHODS: Abstracts dealing with the eradication of Helicobacter pylori have been reviewed and the randomised, controlled studies from European countries were included. The studies were classified into groups based on eradication schedules, antibiotics used and country of provenience. The pooled eradication rates were calculated and the differences were assessed by multiple variance analysis. RESULTS: One-hundred and two studies were accepted comprising 25,644 cases and 398 treatment arms. The eradication rate of proton pump inhibitor-based first line triple therapies was 80.4% (confidence interval: 78.9-81.8); no difference was observed between the five proton pump inhibitors (p > 0.05). Ranitidine bismuth citrate based regimens were efficient in 79.9% (75.7-84.0) (p = 0.95 vs PPI). H2 blockers-based therapies achieved 68.6% (59.0-78.1) (p = 0.0007 vs proton pump inhibitor and p = 0.005 vs ranitidine bismuth citrate-based regimens). Proton pump inhibitor-based double combinations were efficient in 47.1 (31.9-62.4) (p = 0.001 vs triple regimens). Clarithromycin+amoxicillin/nitroimidazole combinations achieved rates of 79.6% and 84.1%, respectively, while amoxicillin-nitroimidazole regimens were less efficient (72.5%, 66.6-78.5) (p = 0.006). The pooled eradication rate of second-line triple regimens was 75.5% (69.9-86.4)(p = 0.08 vs primary treatment). Quadruple therapies were successful in 81.1% (76.6-85.6) of cases as first-line and 73.8% (61.2-86.4) as second-line regimens (p = 0.77 and p = 0.02 vs triple regimens). The pooled eradication rates varied from 58% to 92% in the European countries. CONCLUSIONS: The pooled eradication rate of the primary proton pump inhibitor/ranitidine bismuth citrate-based triple regimens are comparable with the results of meta-analyses. H2 blocker-based triple and proton pump inhibitor-based double regimens are of lower efficacy. Quadruple regimens were not better than triple therapies. The eradication rates per country varied, approaching 80% in most places. The results confirm in part post-hoc the validity of the Maastricht consensus recommendations.

Amoxicillin↗
PubMedDate not supplied

[Patient evolution in different stages of hepatic failure submitted to eradication of esophageal varices with endoscopic ligation].

OBJECTIVE: To know the patients' progress with distinct stages of hepatic failure, according to the Child Pugh classification, who underwent esophageal varices eradication with the use of endoscopic band ligation. DESIGN: Descriptive, longitudinal, prospective and comparative study. CENTRE: Endoscopy Department of the Central Military Hospital, Mexico, D.F. METHODS: One-hundred twenty-four patients with esophageal varices and a history of bleeding, were submitted to various band ligation sessions every 4 weeks until the varices were eradicated and control sessions every 3 months. RESULTS: A total of 425 endoscopy sessions were performed of which 239 were ligature applications and 187 control sessions. Eradication of varices was achieved in 100% of the patients. Of the Child A, 2/3 of them were eradicated in one session and the other 1/3 with 2 sessions. The patients of the Child B class, 66% of varices were effaced in one session, 22% in two and 12% in three sessions. In the Child C group, 50% were obliterated in two sessions, 47% with three, 2% needed 4 sessions. The follow-up period was from 4 months being the minimum and 13 months the maximum (mean of 7 months). In 15% of the patients varices recurred. None were from the Child A group. Those pertaining to the Child B group varices reappeared in 7.3% of which 2/3 required another ligation session to eradicate them once again and the other 1/3 were removed in two sessions. In the Child C group the incidence of recidivation was 28%, 43% of these needing one session to eliminate them once again, 50% two sessions and 7% three sessions for complete eradication. Rebleeding appeared in 7.7% of the sample, all of them were from the Child C class. The occurrence of congestive gastropathy before ligature was 42%, and 73% at the conclusion of the follow-up period. Congestive gastropathy developed in 11% of the Child A patients after eradication, 34% of the Child B group and 38.5% of the Child C group. The incidence of gastric varices was 21% before ligature and at the end of the follow-up period 17% more developed gastric varices. None of the Child A patients developed gastric varices, 12% of group B and 24% of group C. From the (n = 124) 22.5% presented dysphagia as a complication which lasted less than one week and in 0.8% mucosal ulcer CONCLUSION: It is possible to eradicate esophageal varices by band ligation independently of the hepatic function reserve. A greater number of sessions is required to eradicate varices in the poor hepatic function group and the incidence of recidivation, rebleeding, and complications that developed such as gastric varices and gastropathy are more frequent in patients with poor hepatic function reserve.

Adolescent↗
PubMed2005

[The cause of failure of eradication treatment of Helicobacter pylori].

The drug treatment, the combination of lansoprazole + amoxicillin + clarithromycin, for Helicobacter pylori infection with gastroduodenal ulcer was approved for the national heath insurance November 2000 in JAPAN, and has been widely applied. However, failures of eradication have been counted in 10-20% of the cases. The major reason of the failure has been reported as the drug resistance of the H. pylori. Here, we surveyed the antimicrobial resistance of 70 clinical isolates in a Showa University Hospital 2001, 1 to 2002, 1. As a result, the ratio of primary resistance to amoxicillin was about 1.4%, and clarithromycin was about 11.4%. Among 70 H. pylori positive cases, 14 cases were treated with eradication 3 drug combination therapy. In 5 cases, H. pylori were detected after eradication treatment and these five strains acquired the second resistance to neither amoxicillin nor clarithromycin. To distinguish the cause of H. pylori culture-positive after eradication treatment is whether the failure of eradication itself or re-infection, we attempted the analysis of the restriction pattern of H. pylori genome (genome type) using pulsed-field gel electrophoresis. In all 5 cases, genome types of before and after treatment were identical, suggesting the failure of eradication treatment. Three of 5 cases, isolates before and after treatment were susceptible to both of amoxicillin and clarithromycin. Thus, the reason of failure of eradication is considered to ingestion compliance, not antimicrobial agent resistance nor reinfection. The rest of 2 cases, the primary resistance to clarithromycin may result the failure of eradication. Test for drug susceptibility and genome type analysis of H. pylori are significant in certification of an authenticity of an eradication treatment.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

The efficacy of two-week therapy with ranitidine bismuth citrate, amoxicillin and clarithromycin on Helicobacter pylori eradication in clarithromycinresistant and- sensitive cases.

BACKGROUND/AIMS: Recent studies in Turkey have documented the noticeably low success rates of H. pylori eradication. It has become more important to identify the highly successful therapy regimens since clarithromycin resistance, one of the most important factors affecting the success rate of eradication therapies, continues to increase. The aim of this study was to assess the efficacy of two-week therapy with ranitidine bismuth citrate (RBC), amoxicillin (A), and clarithromycin (C) on H. pylori eradication, and the role of C resistance in eradication. METHODS: The study included 45 dyspeptic patients with H. pylori diagnosed by urease test and histopathological examination. C resistance was studied by real-time PCR method on antral biopsy specimens. All patients were treated with a two-week therapy consisting of RBC: 2x400 mg, A: 2x1000 mg, and C: 2x500 mg, daily. Endoscopy was repeated at least one month after the end of the treatment. Presence of H. pylori was investigated by urease test and histopathological examination on antrum and corpus biopsies. Eradication was considered when both tests were negative for H. pylori in all specimens. RESULTS: Two cases were lost to follow-up. The average age of the remaining 43 patients (22 males, 21 females) was 46.3+/-11.5 years. Mild side effects were encountered in 20 (46.5%) patients. Eradication was achieved in 35 (81.4%) patients. C resistance was studied in 26 patients and was detected in 10 (38.5%) of them. H. pylori eradication rate was 81.3% in C-sensitive (13/16) and 80% in C-resistant patients (8/10) (p>0.05). CONCLUSION: A two-week regimen of RBC-A-C is very effective for H. pylori eradication even in C-resistant patients. These results suggest that RBC-A-C combination should be preferred for H. pylori eradication in Turkey.

Amoxicillin↗
PubMed2006

Bismuth-based therapies for the first step eradication of Helicobacter pylori.

BACKGROUND/AIMS: Combination of a proton pump inhibitor, amoxicillin, and clarithromycin, which have been recommended as a primary treatment for Helicobacter pylori (H. pylori) infection, provides eradication in approximately 50% of cases of H. pylori infection in Turkey. There is no effective eradication regimen for H. pylori in our country. We aimed to compare bismuth- based triple and quadruple treatments for eradication of H. pylori. METHODS: Eighty-two patients were enrolled into the study between October 2002 and August 2003. The patients were randomly assigned into two groups. One group received ranitidine bismuth citrate 2x400 mg, metronidazole 3x500 mg and tetracycline 2x1000 mg for 14 days (RMT group) and the other group pantoprazole 2x40 mg, bismuth subcitrate 4x300mg, amoxicillin 2x1000 mg and clarithromycin 2x500 mg for 14 days (PBAC group). The eradication was assessed four weeks after completion of the treatment, and the patients underwent endoscopy and were asked whether there were changes in their symptoms. When H. pylori was negative on both histological examination and urease test, the disease was considered eradicated. RESULTS: H. pylori was eradicated in 26 of 42 patients in the RMT group (61.9%) and in 22 of 40 patients in the PBAC group (55%). In total, eradication was achieved in 48 out of 82 patients (58.5%). There was no significant difference in eradication between the groups. CONCLUSION: Neither regimen (RMT or PBAC) was effective in eradicating H. pylori infection in our area. Further investigations are needed.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2006

[The trend of eradication rates of first-line triple therapy for Helicobacter pylori infection: single center experience for recent eight years].

BACKGROUND/AIMS: The prevalence of antibiotic resistance in Helicobacter pylori (H. pylori) infection has been reported to be increasing. However, the recent trend of eradication rates of H. pylori using first-line triple regimens has been rarely issued. Therefore, we aimed to determine the trend of H. pylori eradication rates in single center for recent eight years. METHODS: From January 1998 through October 2005, H. pylori eradication rates in 525 patients with H. pylori-positive peptic ulcer disease who received one-week triple regimens were retrospectively evaluated according to years, regimens, and ulcer locations. RESULTS: The overall H. pylori eradication rate was 78.7%. Yearly eradication rates from the year 1998 to 2005 were 83.7%, 80.4%, 81.4%, 78.8%, 75.3%, 77.6%, 78.9% and 77.6% consecutively by per-protocol analysis, However, no definite evidence of decreasing tendency of eradication rate was seen during the past eight years (p=0.419). Furthermore, there was no significant difference in the eradication rates according to the ulcer locations and regimens. CONCLUSIONS: Although it is found that there is no definite statistical evidence of decreasing trend for H. pylori eradication rate during past eight years, those for recent 5 years were lower than 80%, which suggests that we should scrutinize the trend of first-line H. pylori eradication rate, and concern for the expected lower rates in the near future.

Adult↗
PubMed1993

Recommendations of the International Task Force for Disease Eradication.

This report summarizes the conclusions of the International Task Force for Disease Eradication (ITFDE), a group of scientists who were convened by a secretariat at the Carter Center of Emory University six times during 1989-1992. The purpose of the ITFDE was to establish criteria and apply them systematically to evaluate the potential eradicability of other diseases in the aftermath of the Smallpox Eradication Program. The ITFDE defined eradication as "reduction of the worldwide incidence of a disease to zero as a result of deliberate efforts, obviating the necessity for further control measures." The names of the members of the ITFDE, the criteria they developed and used, and summaries of the papers that were presented to the ITFDE by various experts are included in this report, as well as a brief history of the concept of disease eradication since the late 19th century. The ITFDE considered more than 90 diseases and reviewed 30 of these in depth, including one noninfectious disease. It concluded that six diseases--dracunculiasis, poliomyelitis, mumps, rubella, lymphatic filariasis, and cysticercosis--could probably be eradicated by using current technology. It also concluded that manifestations of seven other diseases could be "eliminated," and it noted critical research needs that, if realized, might permit other diseases to be eradicated eventually. The successful eradication of smallpox in 1977 and the ongoing campaigns to eradicate dracunculiasis by 1995 and poliomyelitis by 2000 should ensure that eradication of selected diseases will continue to be used as a powerful tool of international public health.

Communicable Disease Control↗
PubMed1996

Helicobacter pylori reinfection after apparent eradication--the Ipswich experience.

The reported rate of Helicobacter pylori reinfection following eradication therapy is highly variable. In Ipswich, the 14C-urea breath test (UBT) has been used since 1986 as a tool to study H. pylori eradication and reinfection. Updated results from 1182 patients in whom the organism had apparently been successfully eradicated, following a number of different eradication regimens between October 1986 and 31 March 1995, are presented. During this period, 57 "reinfections' were observed, of which 45 had occurred within 6 months of treatment. After the first year, the 'reinfection' rate was less than 0.6% per year. The criterion for eradication of the infection was a UBT (2-hour area under curve) of less than 40 at least 1 month after treatment. The treatment regimens were arbitrarily divided into five groups with eradication rates of: less than 20%, 20-39%, 40-59%, 60-79% and over 80%. In these groups, the 6-month 'reinfection' rates were 28.0%, 15.8%, 16.4%, 4.6% and 1.7%, respectively (p < 0.001). These and other data presented in the paper strongly suggest that, in Westernized countries, most so-called reinfections in adults are in fact the late recrudescence of a suppressed infection rather than a true reinfection. Our data also suggest that the true reinfection rate is particularly low if the eradication therapy chosen has an efficacy of more than 85%. Several effective and well-tolerated 1-week triple H. pylori eradication regimens are now available, and we would advocate their use in preference to the less effective dual regimens where initial eradication rates are lower and there is consequently a higher risk of 'reinfection'. We would predict that even in developing countries with a high prevalence of metronidazole-resistant H. pylori, the 'reinfection' rate would be low if a combination of omeprazole, amoxycillin and clarithromycin were to be used.

Adult↗
PubMed1996

[The course of gastric type epithelium in duodenal ulcer and duodenitis; role on the eradication of Helicobacter pylori].

The course of gastric type epithelium during the healing process and beyond the scarring stage of duodenal ulcer was studied in patients with and without Helicobacter pylori (H. pylori) eradication. Materials were consist of 110 patients with active H. pylori ulcers, 27 patients with H. pylori positive ulcer scars and 6 patients with active H. pylori positive duodenitis. The results obtained were as follows. 1) In the non-eradication group, the degree of gastric type epithelium increased as the ulcers healed, but gastric type epithelium remained immature compared with the eradication group. 2) In the non-eradication group, the degree of gastric type epithelium decreased subsequently with or without recurrence of the duodenal ulcer. Under H. pylori positive condition, the degree of gastric type epithelium appeared to be reduced because of invasion by H. pylori. When this condition continued, ulcers probably recurred because of diminished defences against acid in damaged areas of gastric type epithelium. 3) In the successful eradication group, gastric type epithelium became well developed and mature state (grade 4), and remained in this condition for long period because it was not invaded by H. pylori. The appearance of mature state of gastric type epithelium appears to play a role in the prevention of ulcer recurrences by maintaining an adequate defence mechanisms against acid. 4) In the unsuccessful eradication group, the degree of gastric type epithelium remained lower mature state than that of successful eradication group. 5) In cases of H. pylori positive ulcer scar, the degree of gastric type epithelium reached also well developed and mature state when H. pylori was successfully eradicated, and maintained in this condition for a prolonged period. Ulcer recurrence was not observed. 6) In case of H. pylori positive duodenitis, the degree of gastric type epithelium reached mature state after successful eradication, and endoscopic findings of inflammation was improved.

Duodenal Ulcer↗
PubMed1997

Immediate eradication of Helicobacter pylori in patients with previously documented peptic ulcer disease: clinical and economic effects.

OBJECTIVES: The clinical and economic benefits of Helicobacter pylori eradication for patients with newly diagnosed peptic ulcer disease are widely accepted. The objective of this study was to estimate the cost-effectiveness of H. pylori eradication in the large cohort of asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer disease. METHODS: A decision analytic model estimated the clinical and economic effects of two management strategies for asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer: strategy 1-immediate H. pylori eradication therapy and cessation of maintenance therapy, and strategy 2-continued-maintenance antisecretory therapy, with H. pylori eradication therapy reserved for the first symptom recurrence. RESULTS: At 1 yr, the model estimated that immediate H. pylori eradication therapy (strategy 1) led to 22% fewer months with ulcers (28.7 vs. 36.8 ulcer months/100 patient years), 10% fewer months with ulcer symptoms (21.0 vs. 23.1 symptom months/100 patient years), and 24% lower per-patient expenditures ($587 vs. $767/patient year) than maintenance antisecretory therapy and symptom-based H. pylori eradication (strategy 2). Immediate H. pylori eradication, however, resulted in 14% more months with upper gastrointestinal symptoms from all causes (37.9 vs. 33.2 symptom months/100 patient years) than strategy 2, because maintenance antisecretory therapy was effective in treating symptoms due to causes other than peptic ulcer disease. CONCLUSIONS: Ulcer-related outcomes of asymptomatic patients receiving maintenance antisecretory agents for peptic ulcer disease can be improved with immediate H. pylori eradication at reduced cost. Therefore, H. pylori eradication should be aggressively pursued in all patients-symptomatic or not-with previously documented peptic ulcers, who are receiving maintenance antisecretory therapy.

Anti-Ulcer Agents↗