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PubMed2006

Eradication of Helicobacter pylori with triple therapy: an epidemiologic analysis of trends in Turkey over 10 years.

BACKGROUND: There is increasing concern about the efficacy of current regimens for the eradication of Helicobacter pylori. OBJECTIVES: This study examined rates of H. pylori eradication with a commonly used triple-therapy regimen consisting of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin in trials performed in Turkey from 1996 to 2005. It also investigated the relationship between eradication rates and the duration of treatment (7, 10, or 14 days), choice of PPI, and indication for treatment (dyspepsia or peptic ulcer). METHODS: This was a retrospective epidemiologic analysis. Articles concerning H. pylori eradication in Turkey that were published in peer-reviewed national and international journals were identified through searches of MEDLINE using the terms Helicobacter, eradication, and Turkey, and of the Turkish Medical Index using the terms Helicobacter and eradication. Abstracts from the Turkish Gastroenterology Congress from 1996 through 2005 were searched manually. Open-label trials, controlled trials, treatment arms, and case series that included a triple-therapy regimen consisting of standard doses of any PPI (omeprazole 20 mg BID, lansoprazole 30 mg BID, pantoprazole 40 mg BID, or esomeprazole 40 mg BID) with clarithromycin 500 mg BID and amoxicillin 1 g BID for 7 to 14 days were selected for analysis. Trials including patients who had undergone a previous attempt at eradication of H. pylori were excluded. RESULTS: Of 138 trials or treatment arms identified, 94 met the criteria for inclusion (3637 subjects). The pooled eradication rate was 68.8% (95% CI, 67.3-70.3). A marked decrease in eradication was noted after 2000. Pooled eradication rates each year from 1996 through 2005 were 79.4%, 83.7%, 81.8%, 81.8%, 75.1%, 61.3%, 65.6%, 65.1%, 55.3%, and 61.1%, respectively. Eradication rates were not affected by the duration of treatment, choice of PPI, or indication for treatment. CONCLUSIONS: Rates of H. pylori eradication with the triple-therapy regimen decreased in Turkey over the 10-year period studied. In an era of increasing clarithromycin use, the effectiveness of this regimen for H. pylori eradication appears to require reassessment.

Amoxicillin↗
PubMed1999

Basal and stimulated gastrin and pepsinogen levels after eradication of Helicobacter pylori: a 1-year follow-up study.

AIM: A decrease in gastrin and pepsinogen (PG) levels 1 month after Helicobacter pylori eradication has been described repeatedly, but the long-term progression of such a decrease has been scarcely studied. We therefore studied the effect of H. pylori eradication on basal and stimulated gastrin and PG levels for 1 year. Initially, the usefulness of measuring these parameters for the noninvasive diagnosis of H. pylori eradication was validated. Furthermore, an assessment was made of the association between H. pylori reinfection and a re-increase in gastrin and PG values. Finally, an evaluation was made of the variables influencing gastrin and PG concentration, with particular attention to H. pylori infection and histological lesions of gastric mucosa. METHODS: Two-hundred and twenty-two patients with duodenal ulcer were studied prospectively. Exclusion criteria were the administration of antibiotics, H2 antagonists, omeprazole or bismuth prior to endoscopy. In all patients serum basal levels of gastrin, PGI, and PGII were measured before and 1 month after completing eradication therapy. In the successfully eradicated patients, gastrin, PGI, and PGII were also measured at 6 and 12 months. In 80 patients stimulated measurements of gastrin (after ingestion of two beef cubes) and PGI (after injection of pentagastrin) were also performed. H. pylori-negative patients after therapy underwent a urea breath test at 6 and 12 months, and patients who had stimulated gastrin and PG concentration measured had also an endoscopy performed at 6 months. RESULTS: H. pylori was eradicated in 73% of patients. A histological improvement was observed 1 month after completing H. pylori eradication therapy, both at gastric antrum and body (P < 0.001), while a further improvement at antrum was demonstrated at 6 months (P < 0.01). With regard to the different cut-off points for decreased basal and stimulated measurements for diagnosing H. pylori eradication, the best results were obtained, respectively, with PGII (sensitivity of 90% and specificity of 76%) and PGI 30 min after stimulation (sensitivity and specificity of 82%), with an area under the ROC curve of 0.87 in both cases. In the multiple regressions analysis H. pylori status correlated with gastrin, PGI and PGII after therapy (P < 0.001), while histological lesions correlated only with gastrin levels (P < 0.05). A decrease in basal and stimulated serum parameters was demonstrated immediately after eradication (Wilcoxon test, P < 0.001), and an additional decrease (at 6 months) was observed just in PGI (Friedman test, P < 0.01). However, gastrin and PGII values remained unchanged after the first month post-eradication. Seven patients were reinfected with H. pylori during follow-up. Quantitation of basal and stimulated gastrin and PGI levels was not reliable as a reinfection marker. Regarding basal PGII, the parallelism was strong at 6 months (re-increase in all four reinfected patients), although only in one out of three with reinfection at 1 year did PGII rise at that stage. CONCLUSIONS: (1) Measurement of gastrin and PG levels (especially basal PGII values) is a useful non-invasive method to confirm H. pylori eradication after therapy. (2) H. pylori eradication is associated with a significant decrease in basal and stimulated gastrin levels and in basal PGII levels that is detected immediately (1 month) after finishing treatment, and remains unchanged for 1 year. However, the decrease in basal and stimulated PGI levels occurs progressively for 6 months, although such levels remain also unchanged afterwards. (3) Measurement of gastrin and PGI concentrations has a limited usefulness in the diagnosis of H. pylori reinfections after successful eradication, although PGII determination could be more useful in this situation.

Breath Tests↗
PubMed2004

Low eradication rate of Helicobacter pylori with triple 7-14 days and quadriple therapy in Turkey.

AIM: The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication. METHODS: One hundred and sixty-four H pylori positive patients (68 males, 96 females; mean age: 48+/-12 years) with duodenal or gastric ulcer without a smoking history were included in the study. The patients were divided into three groups according to the treatment regimens. Omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g were given twice daily for 1 week (Group I) and 2 weeks (Group II). Patients in Group III received bismuth subsitrate 300 mg, tetracyline 500 mg and metronidazole 500 mg four times daily in addition to Omeprazole 20 mg twice daily. Two biopsies each before and after treatment were obtained from antrum and corpus, and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment. The effects of factors like age, sex, H pylori density on antrum and corpus before treatment, the total H pylori density, and the inflammation scores on the rate of H pylori eradication were evaluated. RESULTS: The overall eradication rate was 42%. The rates in groups II and III were statistically higher than that in group I (P<0.05). The rates of eradication were 24.5%, 40.7% and 61.5% in groups I, II and III, respectively. The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P<0.05). The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr, P<0.001). No correlation between sex and H pylori eradication was found. CONCLUSION: Our rates of eradication were significantly lower when compared to those reported in literature. We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.

Adolescent↗
PubMed1998

Failure-as-success: multiple meanings of eradication in the Rockefeller Foundation Sardinia project, 1946-1951.

In the history of malaria control programs there were important tensions between proponents of the concept of eradication and those of malaria control. In this debate the concept of eradication has had multiple meanings. This paper concerns the post-hoc interpretations of the outcomes of the Rockefeller International Health Foundation-sponsored project conducted in Sardinia between 1946 and 1951. The Ente Regionale per la Lotta Anti-Anofelica in Sardegna (regional agency for the anti-Anopheles struggle in Sardinia) (ERLAAS) project was conceived as a large-scale, field-based pilot demonstration project to test the feasibility of the strategy of "species eradication" in an area with an endemic malaria vector. Species eradication, a strategy championed by Soper, was aimed at the total annihilation of an anopheline vector from an area. Under the leadership of the Rockefeller Foundation, the ERLAAS project used postwar UNRRA funds to purchase local labor and imported DDT, oil-suspension, and war-surplus equipment in an "all-out" campaign against Anopheles labranchiae, even in sparsely populated areas. The original aim was entirely entomological; species eradication was expected to be completed in two years for a cost of $2.7 million. Ironically, malaria mortality on the island had already been lowered before WWII by a series of public health interventions. The ERLAAS project encountered severe technical and logistical difficulties; its ultimate failure was foreshadowed in the resignation of the first American director who doubted the feasibility of species eradication. Ultimately, the ERLAAS project was ended after four and a half years and an expenditure of $11.2 million. Although new malaria transmission on the island ended the project failed to eliminate A labranchiae. Finally, the regional government was counselled to continue mosquito control efforts; the continuation of a substantial mosquito control program for fifty years after this famous "malaria eradication" project runs contrary to the basic cost/benefit logic of the eradication concept. Nevertheless, in the popular press both in the U.S. and Italy, the project was presented and heralded as a major success in liberating the island from the age-old stranglehold and misery of malaria. In the course of the project, the goals of ERLAAS became transformed from species eradication to malaria eradication; this was an important political spin that was put on the evaluation of the program. The consequences of this tactical change in discourse included two important facts: the contribution of the Rockefeller Foundation to the island was exaggerated, and the legitimacy of the concept of global eradication was maintained. In the framework of the World Health Organization and the agreement for a global malaria eradication program, the "failure" of the Sardinia project was seldom recognized or mentioned. The technical, economic, and logistical problems faced by ERLAAS were very similar to the problems associated with the end of the WHO global malaria eradication policy in 1972. The Sardinia project is presented as a case of "failure-as-success"; an ideological transformation was made, not simply for local political expediency, but more importantly because of the predominance of the modernist cultural model of "progress through technology" that characterized international Public Health in the postwar era.

Animals↗
PubMed2006

Effects of esophageal varice eradication on portal hypertensive gastropathy and fundal varices: a retrospective and comparative study.

Esophageal varice eradication results in gastric hemodynamic changes. The aim of this study was to detect the influence of variceal eradication on portal hypertensive gastropathy (PHG) and fundal varices and to compare the results of two therapeutic methods (endoscopic variceal ligation and endoscopic sclerotherapy). A total of 114 consecutive patients with cirrhosis and portal hypertension who underwent elective endoscopic variceal ligation (EVL) (85 patients) or endoscopic sclerotherapy (EST) (29 patients) for obliteration of esophageal varices were selected for this study. Both groups were compared for PHG and fundal varice formation before and after eradication. Fifty-eight (68.2%) patients in the EVL and 18 (62.1%) patients in the EST group had PHG before esophageal varice eradication (P > 0.05). PHG grade after eradication of esophageal varices by both EVL and EST was significantly higher compared to pre-eradication. PHG grade and aggregation were similar in both groups. Thirty-seven patients (34 F(1), 3 F(2)) in the EVL group and 13 patients (10 F(1), 3 F(2)) in the EST group had fundal varices before variceal eradication (P > 0.05). Fundal varices were detected in 46 (35 F(1), 11F(2)) and 19 (11F(1), 8F(2)) patients in the EVL and EST groups after eradication, respectively. There was a statistically significant increment in occurrence of fundal varices after eradication with EVL and EST groups. There was no significant difference regarding fundal varice development after esophageal variceal eradication in both groups. After varical eradication, PHG was found in 57 (87.7%) and 39 (79.6%) patients with and without fundal varices, respectively (P > 0.05). Esophageal eradication with EVL and EST increases both the incidence and the severity of PHG and fundal varice formation. Both methods have comparable influences on PHG and fundal varices.

Adult↗
PubMed2004

Effect of antibacterial therapy and salivary secretion on the efficacy of Helicobacter pylori eradication in duodenal ulcer patients.

OBJECTIVE: Oral health status may play a role in Helicobacter pylori eradication. Because adequate secretion of saliva promotes oral health, the aim of the study was to assess the effect of salivary secretion on the efficacy of H pylori eradication from the stomach. STUDY DESIGN: The study involved 90 H pylori-positive subjects with duodenal ulcer (68 men, 22 women, aged 20-70 years) in whom saliva was collected under basal conditions for 45 min before antibacterial treatment began. They received no drugs for at least 3 days prior to saliva collection. A 7-day course of either of 2 eradication regimens--omeprazole, amoxicillin, and tinidazole (OAT); or omeprazole, amoxicillin, and clarithromycin (OAC)--was used. The efficacy of eradication therapy was evaluated 30 days after its completion. RESULTS: The efficacy of H pylori eradication from the stomach (per protocol analysis) was 77.5% in the group of subjects treated with OAT and 81.6% with OAC. Combined analysis of both groups (OAT+OAC) showed reduced salivary secretion in subjects with eradication failure (0.395 +/- 0.266 vs 0.25 +/- 0.176 mL/min, P=.042). A similar outcome was obtained when the OAT group was analyzed separately (0.436 +/- 0.316 vs 0.211 +/- 0.216 mL/min, P=.022), but in the OAC group the difference was not significant. In the combined analysis, the efficacy of eradication therapy was lower in women than in men (52.9% vs 86.9%, P=.005). In women, it corresponded to salivary secretion (successful eradication 0.337 +/- 0.133 mL/min, unsuccessful eradication 0.180 +/- 0.144 mL/min, P=.043); whereas in men, the difference was not significant (successful eradication 0.405 +/- 0.282 mL/min, unsuccessful eradication 0.321 +/- 0.186 mL/min). CONCLUSION: Low salivary secretion may contribute to the decrease in efficacy of H pylori eradication from the stomach, at least in subjects treated with certain drug regimens.

Adult↗
PubMed2006

Successful and currently ongoing parasite eradication programs.

The eradication of parasitic diseases is not a new concept. The most successful programs of parasite eradication have occurred with species of veterinary importance. The first such program, the eradication of Texas Cattle Fever from the United States, is one of the great success stories of disease eradication. The American screwworm eradication program is ongoing and is serving as a guiding impetus for many of the ongoing or proposed vector eradication schemes around the world. The success of these programs prompted similar successful operations in human health. Although they once led the way, veterinary parasitologists have taken second place in eradication planning. The only three parasitic diseases of veterinary importance that have been targets of recent eradication programs are Hypoderma species in Great Britain and Europe, Cochliomyia hominivorax after its introduction into Libya from the Americas, and Echinococcus granulosus in Tasmania, Australia. There is also work on the eradication of the tick, Amblyomma variegatum, from the Caribbean Islands. Some animal diseases are targeted under the auspices of the human eradication programs, most notably the eradication of the tsetse fly from parts or all of Africa. This paper reviews some of the past or ongoing successful eradication programs and presents a brief summary of the history of the programs, the methods used or planned, and potential controversies surrounding their success and implementation.

Animals↗
PubMed2003

Gene expression of ornithine decarboxylase, cyclooxygenase-2, and gastrin in atrophic gastric mucosa infected with Helicobacter pylori before and after eradication therapy.

H. pylori (Hp) -induced atrophic gastritis is a well-known risk factor for the development of gastric cancer. Whether Hp eradication can prevent or retard the progress of atrophy and metaplasia has been the topic of numerous studies but the subject remains controversial. Recently, the increased expression of ornithine decarboxylase (ODC), gastrin and cyclooxygenase (COX)-2 has been shown to be increased in premalignant lesions in gastric mucosa and to play an essential role in the malignant transformation. The aim of the study is to assess the effect of eradication therapy on atrophic gastritis and analyze the gene expression for ODC, COX-2 and gastrin in gastric mucosa after succesful eradication in patients with atrophic gastritis. Twenty patients with chronic atrophic gastritis including both corpus and antrum of the stomach were included in this study. Four antral mucosal biopsy specimens were obtained from antrum and four from corpus. The histopathologic evaluation of gastritis was based on Sydney classification of gastritis. All patients were Hp positive based on the [13C] urea breath test (UBT) and the presence of anti-Hp IgG and anti-CagA-antibodies detected by ELISA. The patients were then eradicated with triple therapy consiting of omeprazol (2 x 20 mg), amoxycillin (2 x 1 g) and clarithromycin (2 x 500 mg) for seven days and vitamin C 1 g/day for three months. In gastric mucosal samples obtained from the antrum and corpus before and after eradication, the mRNA expression for ODC, COX-2, and gastrin was assessed by reverse-transcription polymerase chain reaction (RT-PCR). In all patients the gastric secretory analysis was performed by measuring gastric acid output and serum gastrin levels. After triple therapy the successful eradication assessed by UBT was observed in 95% of patients. In 45% of patients the infection with CagA-positive Hp strain was observed. Three months after eradication a significant reduction in the gastric activity (neutrophilic infiltrate) and severity (mononuclear infiltrate) of gastritis was observed. The atrophy score improved in both antrum and corpus after eradication. The expression of COX-2 and ODC was significantly up-regulated in the gastric mucosa of patients with atrophic gastritis and significantly reduced after eradication therapy. In all successfully eradicated patients with atrophic gastritis a significant increase in gastric acid secretion and decrease in serum gastrin were observed. We conclude that: (1) Hp eradication leads to the decrease in ODC and COX-2 gene expression in the gastric mucosa, and this may be relevant for the prevention of the Hp-associated gastric carcinogenesis; and (2) gastric atrophy ameliorates upon successful Hp eradication therapy.

Amoxicillin↗
PubMed1996

Clarithromycin and omeprazole as helicobacter pylori eradication therapy in patients with H. pylori-associated gastric disorders.

Helicobacter pylori is susceptible to many antibacterial drugs in vitro but has proved difficult to eradicate in vivo. The macrolide clarithromycin has good activity against H. pylori in vitro and has demonstrated the highest eradication rate for any antibacterial monotherapy in vivo. However, it is clear that antibacterial monotherapy is not a sufficiently effective treatment for patients with H. pylori infection. The suggestion that high intragastric acidity impairs the action of antibacterial drugs led to the evaluation of combination H. pylori eradication regimens including H+,K+-ATPase inhibitors and antibacterial drug(s) with or without bismuth compounds. Noncomparative studies evaluating the efficacy of dual therapy with clarithromycin plus omeprazole in patients with H. pylori infection have reported eradication rates of between 58 and 83% > or = 4-weeks after therapy. In comparative studies, clarithromycin plus omeprazole was at least as effective as amoxicillin plus omeprazole. However, direct comparisons have shown that eradication rates achieved by dual therapy are not as high as those achieved by triple therapy. Indeed, triple therapy with clarithromycin plus omeprazole in combination with amoxicillin or a nitroimidazole has achieved eradication rates of up to 100%. Although 14-day triple drug regimes were initially considered necessary for effective eradication, it now seems clear that 7-day regimes are equally effective. Factors known to influence response to H. pylori eradication therapy include bacterial resistance and patient compliance. A review of 4 studies evaluating the efficacy of dual eradication therapy with clarithromycin plus omeprazole reported an overall incidence of adverse events (patient or investigator reported, whether related to treatment or not) of 45%. The most common adverse event was taste disturbance (an adverse event commonly reported during the development of clarithromycin); nausea, headache, diarrhoea, vomiting and abdominal pain occurred less frequently. Although dual therapy might be expected to cause fewer adverse events than triple therapy this has not been the case in direct comparisons conducted to date. Thus, although clarithromycin plus omeprazole is associated with an H. pylori eradication rate of approximately 70%, 1 week of triple therapy with these 2 drugs together with amoxicillin or a nitroimidazole, which eradicates the organism in approximately 90% of cases, may represent optimal H. pylori eradication therapy.

Anti-Bacterial Agents↗
PubMed1999

Decision analysis of histamine H2-receptor antagonist maintenance therapy versus Helicobacter pylori eradication therapy: a randomised controlled trial in patients with continuing pain after duodenal ulcer.

BACKGROUND: Much has been published on the efficacy and cost effectiveness of Helicobacter pylori eradication treatment as an alternative to histamine H2-receptor antagonist maintenance treatment in peptic ulcer disease. However, most studies have analysed and emphasised H. pylori eradication rates rather than management/control of symptoms and the associated cost savings. Although H. pylori eradication therapy is very successful in clearing the infection, dyspeptic symptoms may persist and management of these can be expensive. OBJECTIVE: The aim of this study was to assess the cost implications in controlling symptoms using either H2-receptor antagonist maintenance therapy or H. pylori eradication therapy in patients with duodenal ulcer disease. DESIGN: This was a non-blind, prospective, randomised, parallel-group study comparing maintenance H2-receptor antagonist treatment using ranitidine with H. pylori eradication therapy, with a 1-year follow-up. SETTING: This was a study of outpatients from general practices in Dundee, Scotland, or the Ninewells Hospital, Dundee, gastroenterology clinic. PATIENTS AND PARTICIPANTS: 119 patients with confirmed duodenal ulcer, free from active ulceration at study entry but positive for H. pylori infection, who were receiving maintenance H2-receptor antagonist therapy. INTERVENTIONS: Patients were randomised to receive either continuing maintenance therapy with ranitidine (initially 150 mg daily; 58 patients) or H. pylori eradication therapy using an omeprazole/amoxicillin/metronidazole regimen (or omeprazole/clarithromycin if allergic to penicillin). MAIN OUTCOME MEASURES AND RESULTS: Overall, H. pylori eradication rates were 100% per protocol and 95.1% intention-to-treat. At completion of 1 year of follow-up, 12 of the 61 (19.7%) patients successfully eradicated of H. pylori were still dependent on acid suppression for symptom relief. H. pylori eradication treatment was the least-cost strategy in managing/controlling symptoms at 1 year (168 Pounds vs 210 Pounds per patient; 1996 values). However, over time, post-eradication treatment costs were greater than H2-receptor antagonist therapy costs. Any potential savings were directly related to the proportion of patients needing further treatment post-eradication, the cost of endoscopy and the urea breath test. CONCLUSIONS: If dyspepsia persists long term, H. pylori eradication treatment may not be the least-cost option for patients with duodenal ulcer.

Decision Support Systems, Clinical↗
PubMed2004

Maastricht II treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori.

AIM: The Maastricht II criteria suggest the use of amoxicillin and clarithromycin in addition to a proton pump inhibitor over 7-10 d as a first line therapy in the eradication of Helicobacter pylori (H pylori). For each proton pump inhibitor, various rates of eradication have been reported. The present study was to compare the efficacy of different proton pump inhibitors like omeprazole, lansoprazole and pantoprazole in combination with amoxicillin and clarithromycin in the first line eradication of H pylori and to investigate the success of H pylori eradication in our district. METHODS: A total of 139 patients were included having a Helicobacter pylori (+) gastroduodenal disorders diagnosed by means of histology and urease test. Besides amoxicillin (1000 mg twice a day) and clarithromycin (500 mg twice a day), they were randomized to take omeprazole (20 mg twice a day), or lansoprazole (30 mg twice a day), or pantoprozole (40 mg twice a day) for 14 d. Four weeks after the therapy, the eradication was assessed by means of histology and urease test. It was evaluated as eradicated if the H pylori was found negative in both. The complaints (pain in epigastrium, nocturnal pain, pyrosis and bloating) were graded in accordance with the Licert scale. The compliance of the patients was recorded. RESULTS: The eradication was found to be 40.8% in the omeprazole group, 43.5% in the lansoprazole group and 47.4% in the pantoprazole group. Sixty-three out of 139 patients (45%) had eradication. No statistically significant difference was observed between the groups. Significant improvements were seen in terms of the impact on the symptom scores in each group. CONCLUSION: There was no difference between omeprazole, lansoprazole and pantoprazole in H pylori eradication, and the rate of eradication was as low as 45%. Symptoms were improved independent of the eradication in each treatment group. The low eradication rates suggest that the antibiotic resistance or the genetic differences of the microorganism might be in effect. Further studies are required to verify these suggestions.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

[The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication].

None of the drug regimens used to treat H. pylori infection ensures 100% of efficacy. One may think therefore that among factors modifying H. pylori eradication there are also cigarette smoking and alcohol consumption. The aim of the study was to determine the influence of cigarette smoking and alcohol consumption on efficacy of H. pylori eradication. The study was conducted on 142 H. pylori positive peptic ulcer patients treated with either OAT-omeprazole (2 x 20 mg), amoxycillin (2 x 1000 mg), tinidazole (2 x 500 mg) (69 patients) or OAC-omeprazole (2 x 20 mg), amoxycillin (2 x 1000 mg), clarithromycin (2 x 250 mg) (73 patients). Detailed information on smoking and drinking habits was obtained from a questionnaire fulfilled by all subjects. Patients were defined as smokers if smoked 5 or more cigarettes per day and as drinkers if drank 25 g or more alcohol per week. To enter the study patients had to have confirmed H. pylori infection by two tests (CLO-test and histology). Eradication was considered successful if both tests gave negative results 4-6 weeks after the cessation of treatment. The efficacy of H. pylori eradication was similar in both groups (OAT--69.6%, OAC--78.1%). Patients who smoked cigarettes had lower rate of H. pylori eradication in OAC group (smokers 65.8%, non-smokers 91.4%, p < 0.01), while patients who drank alcohol had higher eradication rate in OAT group (drinkers 85.2%, non-drinkers 59.5%, p < 0.05). When two factors (smoking, drinking) were analyzed together, it was found that in drinkers treated with OAT, smoking did not change the efficacy of H. pylori eradication, while in non-drinkers decreased by two times (75.0% vs 38.9%, p < 0.02). In drinkers treated with OAC, smoking did not change the efficacy of H. pylori eradication (but this was likely related to the limited number of patients), while decreased it in non-drinkers from 90.0% to 65.2% (p < 0.05). When two groups were analyzed together (OAT + OAC), the lowest efficacy of H. pylori eradication exhibited smokers who do not drink (53.7%) followed by smokers who drink (75.8%), non-smokers who do not drink (83.3%) and non-smokers who drink (92.9%); in each case the efficacy of eradication was higher than in smokers who do not drink (p < 0.05, p < 0.01, p < 0.01, respectively). Both cigarette smoking and alcohol consumption can affect the efficacy of H. pylori eradication. Smoking and drinking habits should be taken into account, when the set of drugs for H. pylori eradication is chosen.

Adult↗
PubMed2003

Follow-up survey of a large-scale multicenter, double-blind study of triple therapy with lansoprazole, amoxicillin, and clarithromycin for eradication of Helicobacter pylori in Japanese peptic ulcer patients.

BACKGROUND: To evaluate histopathological changes and effects on inhibition of ulcer recurrence, a follow-up survey was performed in Japanese patients with Helicobacter pylori-positive active peptic ulcers. These patients had previously participated in a large-scale multicenter trial of triple therapy with lansoprazole (LPZ)/amoxicillin (AMPC)/clarithromycin (CAM) for eradication of H. pylori. METHODS: Patients who had been treated with LPZ only or a combination of LPZ, AMPC, and CAM for a period of 7 days and in whom ulcer healing had been confirmed after treatment were grouped according to successful or failed eradication of H. pylori. They were examined endoscopically to determine whether ulcers had recurred. The updated Sydney system was applied to study histological changes after H. pylori eradication therapy, compared with baseline. RESULTS: Twelve months after treatment for H. pylorieradication, gastric ulcers had recurred in 11.4% of those with successful H. pylorieradication and in 64.5% of those with unsuccessful H. pylori eradication. Duodenal ulcers had recurred in 6.8% of patients for whom H. pylori eradication was successful and in 85.3% of patients in whom eradication failed. These findings proved that H. pylori eradication significantly reduced ulcer recurrence ( P < 0.0001 for both types of ulcers). Histopathological findings of inflammation and activity grade in both gastric and duodenal ulcers were more favorable in patients with successful eradication than in those with unsuccessful eradication. CONCLUSIONS: H. pylori eradication significantly inhibited ulcer recurrence in Japanese peptic ulcer patients. Histopathological findings were also improved with regard to inflammation and activity (neutrophils) in patients in whom H. pylori eradication was successful.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Empirical Helicobacter pylori "rescue" therapy after failure of two eradication treatments.

AIM: Even with the current most effective Helicobacter pylori treatment regimens, approximately 20% of patients do not eradicate the infection. Several "rescue" therapies have been recommended, but they still fail to eradicate H. pylori in approximately 20-30% of the cases. Our aim was to evaluate the efficacy of different rescue therapies prescribed to patients in whom two consecutive H. pylori eradication regimens had failed. METHODS: Design. Prospective single-centre study. Patients. Consecutive patients in whom two eradication regimens had failed to eradicate H. pylori. Intervention. Third eradication regimens included: (1) omeprazole-amoxicillin-clarithromycin for 7 days; (2) quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole for 7 days; (3) omeprazole-amoxicillin-clarithromycin-bismuth for 14 days; and (4) omeprazole-amoxicillin-rifabutin for 14 days. H. pylori antibiotic susceptibility was unknown and, therefore, rescue regimens were chosen empirically. In no case, was the same regimen repeated. Outcome. H. pylori eradication was defined as a negative in 13C-urea breath test 8 weeks after completing the therapy. RESULTS: Forty-eight patients were included (mean age 45 years, 44% males, 82% with peptic ulcer and 18% with functional dyspepsia). No patient was lost from follow-up. Adverse effects were described in 21% of the patients. One patient receiving omeprazole, amoxicillin and rifabutin was removed from medication due to adverse effects (vomiting). Overall, mean H. pylori eradication with third therapy after failure of two eradication treatments was 34/48 (71%; 95% confidence interval 57-82%) by intention-to-treat and 34/47 (72%; 95% confidence interval 58-83%) by per-protocol. CONCLUSION: It seems that performing culture even after a second eradication failure may not be necessary, as it is possible to construct an overall strategy to maximise H. pylori eradication, based on the different possibilities of empirical treatment.

Adult↗
PubMed2005

Is there any correlation between 13C-urea breath test values and response to first-line and rescue Helicobacter pylori eradication therapies?

AIM: To study if there is a correlation between 13C-urea breath test values prior to treatment and the response to first-line and rescue Helicobacter pylori eradication therapies. METHODS: Six-hundred patients with peptic ulcer or functional dyspepsia infected by H. pylori were prospectively studied. Pre-treatment H. pylori infection was established by 13C-urea breath test. Three-hundred and twelve patients were treated with first-line eradication regimen, and 288 received a rescue regimen. H. pylori eradication was defined as a negative 13C-urea breath test, 8 weeks after completion of treatment. RESULTS: H. pylori eradication was achieved in 444 patients. No statistically significant differences were demonstrated when mean delta 13C-urea breath test values were compared between patients with eradication success and failure (49.4+/-33 versus 49.2+/-31). Differences in mean pre-treatment delta 13CO2 between patients with eradication success/failure were not demonstrated either when first-line or rescue regimens were prescribed. With the cut-off point of pre-treatment delta 13CO2 set at 35 units, sensitivity and specificity for the prediction of H. pylori eradication success was 43 and 60%. The area under the receiver operating characteristic curve evaluating all the cut-off points of the pre-treatment delta 13CO2 for the diagnosis of H. pylori eradication was 0.5. Finally, delta 13CO2 values did not influence the eradication in the logistic regression model. CONCLUSION: No correlation was observed between 13C-urea breath test values before treatment and the response to first-line and rescue H. pylori eradication therapies. Therefore, we conclude that the quantification of delta 13CO2 prior to treatment is not useful to predict the success or failure of eradicating therapy.

Antacids↗
PubMed2004

Reflux esophagitis after eradication of Helicobacter pylori is associated with the degree of hiatal hernia.

BACKGROUND: Several studies have shown that reflux esophagitis (RE) occurs after eradication of Helicobacter pylori. However, endoscopic findings do not allow prediction of the development of RE after successful treatment. In this study, we evaluated the relationship between the prevalence of RE after eradication therapy and the degree of hiatal hernia. METHODS: The study comprised 148 patients who had undergone H. pylori eradication therapy over the past 5 years. The degree of RE and hiatal hernia was evaluated based on endoscopic findings. Hiatal hernia was graded according to Hill's gastroesophageal flap valve (GEFV; grades I-IV) classification. RE after eradication therapy was graded according to the Los Angeles classification system. H. pylori infection was confirmed in all patients by culture, urease test and histological examination of antral and fundic biopsy specimens. RESULTS: Among 148 patients, there were 122 patients (82.4%) with successful and 26 (17.6%) with failed eradication therapy. RE was diagnosed in 25 (20.5%) out of 122 patients with successful therapy but only in 1 (3.8%) out of 26 patients with failed therapy (P < 0.05). After successful eradication, 25 patients had mild RE (12 with grade A, 13 with grade B). Among patients of the successful eradication group (n = 122), RE was diagnosed in 2 (5.3%) out of 38 patients without hiatal hernia and in 23 (27.4%) out of 84 patients with hiatal hernia (P = 0.0051). Furthermore, RE was diagnosed in 2 (5.3%) out of 38 patients with GEFV grade I, 13 (24.1%) out of 54 with grade II, 7 (30.4%) among 23 with grade III, and 3 (42.9%) out of 7 patients with grade IV. The pH level of gastric juice after eradication therapy was lower in the group with successful eradication than in the group with failed therapy regardless of the incidence and degree of RE. CONCLUSIONS: There is a high incidence of RE after successful H. pylori eradication therapy. This incidence of RE was closely associated with the presence and degree of hiatal hernia and with the decrease in gastric juice pH. These findings suggest that the presence of hiatal hernia together with increase in gastric acidity are important determinant factors for the development of RE after successful H. pylori eradication therapy.

Endoscopy, Gastrointestinal↗
PubMed1995

Helicobacter pylori eradication in the African setting, with special reference to reinfection and duodenal ulcer recurrence.

The aim of this study was to determine the effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease, and to determine the incidence of reinfection in adult patients where H pylori had been eradicated in a community with a high prevalence of the infection. An investigator blinded study, with 24 month endoscopic follow up, in subjects where H pylori had been eradicated, and similarly treated subjects where it had not been eradicated was conducted at a tertiary referral hospital. The patients consisted of a volunteer sample of 48 patients with endoscopically proved active duodenal ulcer disease. Duodenal ulcers were healed with omeprazole, 20 mg/day. After endoscopically confirmed healing, patients were treated with either one (17 patients) or two weeks (31 patients) of 'triple therapy'. H pylori status (urease reaction, histological tests, and culture of antral biopsy specimens) was determined at entry, four weeks after the finish of triple therapy and six, 12, and 24 months after this, or whenever an endoscopically proved recurrent duodenal ulcer was found. The main outcome measures were the recurrence of duodenal ulceration, over 24 months in the eradicated and non-eradicated groups and the incidence of reinfection by H pylori in the eradicated group during this follow up period. Five patients in the eradicated group experienced a duodenal ulcer relapse, of which only three were unexplained (1 = reinfected, 1 = gastrinoma). Fifteen of 21 patients in the non-eradicated group relapsed over the same period (p < 0.001). Only two of 27 patients in the eradicated group were reinfected during the 24 month follow up period. It is concluded that H pylori eradication is an effective treatment strategy for the longterm treatment of duodenal ulcer disease, even in the high prevalence, African setting. Reinfection is uncommon.

Adult↗
PubMed1999

Eradication of vaccine-preventable diseases.

Eradication is the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. To date, the only infectious disease that has been eradicated is smallpox. Poliomyelitis is targeted for eradication by the year 2000, and the eradication initiative is well under way, with the Western Hemisphere certified as being polio-free and more than one year having passed since polio cases occurred in the Western Pacific Region of the World Health Organization. A review of the technical feasibility of eradicating other diseases preventable by vaccines currently licensed for civilian use in the United States indicates that measles, hepatitis B, mumps, rubella, and possibly disease caused by Haemophilus influenzae type b are potential candidates. From a practical point of view, measles seems most likely to be the next target. Global capacity to undertake eradication is limited, and care must be taken to ensure that a potential measles eradication effort does not impede achievement of polio eradication. Even in the absence of eradication, major improvements in control are both feasible and necessary with existing vaccines. New and improved vaccines may give further possibilities of eradication in the future. Eradication represents the ultimate in sustainability and social justice.

Bacterial Infections↗