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PubMed2002

Helicobacter pylori eradication for peptic ulceration: an observational study in a Scottish primary care setting.

Despite being established for the treatment of peptic ulcer (PU) disease, few studies have assessed the long-term effectiveness and economic benefits of Helicobacter pylori (Hp) eradication in primary care. Our aim was to investigate the effect of community based Hp eradication for patients with chronic peptic ulcer disease requiring maintenance acid suppression. The endpoints used were the patients dyspeptic symptoms and the requirement for the prescription of maintenance acid suppression therapy. The study area covered seven general practices in the Glasgow area. Patients with previously diagnosed peptic ulcer disease receiving prescribed acid suppression therapy were invited to a dyspepsia clinic. Hp status was assessed by Helisal rapid blood test (HRBT). Positive patients received Hp eradication therapy and were reviewed six weeks later. At six months a review of practice records was carried out, and two years after eradication a postal questionnaire was sent to participating patients. A total of 243 patients attended the initial clinic of which 81.9% were HRBT positive. 156 of 196 patients offered Hp eradication re-attended at six weeks. The per protocol eradication rate was 91.7%. After six months patients who had received eradication therapy were less likely to require maintenance acid suppression therapy compared with those to whom eradication was not given. Two years after treatment 76.5% of patients felt their symptoms were improved, but 42.2% were still receiving maintenance therapy. The estimated cost of treatment per month per patient had fallen from 20.23 Pounds to 9.39 Pounds after eradication. In conclusion we felt that community based Hp eradication for patients with chronic PU disease is effective, however it does not completely alleviate dyspepsia. Predictors of symptomatic response or of no longer requiring acid suppression therapy after two years were younger age of onset of PU disease and absence of pre-documented gastro-oesophageal reflux disease or hiatus hernia. Hp eradication improves patients symptoms, reduces the requirement for maintenance acid suppression and is cost-effective after two years follow-up in this targeted group.

Female↗

PubMed1999

Long-term follow-up study of serum immunoglobulin G and immunoglobulin A antibodies after Helicobacter pylori eradication.

OBJECTIVE: There have been few studies concerning serum titers of anti-Helicobacter pylori immunoglobulin G (IgG) antibody >12 months after eradication of the original infection. Moreover, clinical usefulness of immunoglobulin A (IgA) antibody levels remains to be established. The purpose of this study was to investigate long-term responses of serum IgG-specific and IgA-specific antibodies to H pylori in children after eradication therapy. STUDY DESIGN: A total of 34 children, 2 to 17 years of age (mean: 11.7 years) with H pylori-associated gastroduodenal disease received eradication therapy (proton pump inhibitor-based dual or triple regimens). Diagnoses included nodular gastritis (n = 8), gastric ulcer (n = 7), and duodenal ulcer (n = 19). Upper gastrointestinal endoscopy and biopsy were performed before the therapy and at 1 to 2 months' posttreatment. H pylori infection and eradication were defined by biopsy-based tests; eradication was successful in 28 patients and unsuccessful in 6. Pretreatment IgG was positive in 30 patients (88. 2%), and the IgA was positive in 31 (91.2%), who were entered into this study (duration </=24 months). Serum samples were obtained before treatment and at 1, 3, 6, 12, 18, and 24 months' posttreatment. IgG and IgA antibodies were measured using commercial enzyme immunoassay kits (HM-CAP and PP-CAP; Enteric Products, Inc, New York, NY). RESULTS: Compared with pretreatment values, IgG and IgA antibodies significantly and steadily decreased at 1 through 24 months' posttreatment in successfully treated patients. A decrease in titer of the IgA class was significantly greater than that of the IgG class at 1 to 12 months' follow-up. There was no significant decrease in titer of either antibody in all but 2 patients with eradication failure. A >/=30% decrease in titer of the IgA antibody at 6 months indicated eradication with sensitivity of 90.5% and specificity of 100%. For the IgG antibody, a 30% decrease at 12 months showed equal sensitivity and specificity. Seroreversion rates of IgG and IgA antibodies were 53% and 48% at 12 months and were 86% and 81% at 24 months, respectively. The mean periods from the completion of eradication therapy to seroreversion of IgG and IgA antibodies were 11.2 +/- 7.0 and 11.6 +/- 7.8 months, respectively (not significantly different). A higher pretreatment titer of IgG antibody was related to a longer period of seroreversion (r = 0.44). In one patient, (13)C-urea breath test-confirmed reinfection was accompanied by reappearance of significant titers of the IgG and IgA antibodies. CONCLUSIONS: A serology test is useful for evaluating eradication in children. Approximately half of patients with successful eradication remained to be IgG-seropositive and IgA-seropositive at 12 months' posttreatment. When a decrease titer in antibody is used for assessing eradication, an endpoint of >/=6 months is required. The IgA antibody may be a more convenient indicator of H pylori status than is the IgG antibody.

Adolescent↗

PubMed1996

Decision analysis of Helicobacter pylori eradication therapy using omeprazole with either clarithromycin or amoxicillin.

In patients with duodenal ulcer, omeprazole plus clarithromycin (OC) has achieved Helicobacter pylori eradication rates of about 80%, compared with 50% for omeprazole plus amoxicillin (OA). The drug acquisition costs for OC are 102.92 pounds sterling (pounds) compared with 38.96 pounds for OA using generic amoxicillin and 51.63 pounds using the proprietary brand 'Amoxil' (costs for 2-week regimens in 1995). The aim of this analysis was to estimate the total healthcare costs to the general practitioner (GP) of eradication therapy using a simple generalised model. Data about current practice in the UK were obtained from 502 respondents in a survey of hospital specialists and GPs. It was assumed that patients would derive no benefit from eradication therapy unless they had a duodenal ulcer, and that all OA patients received generic amoxicillin. The survey confirmed that OA was the commonest eradication therapy prescribed by UK GPs at that time. Three distinct patient groups were identified: patients with proven duodenal ulcer who were already receiving maintenance treatment with a histamine H2 receptor antagonist, and new patients with dyspepsia who were subdivided into those aged above or below 45 years. Patients receiving maintenance treatment for a duodenal ulcer would be prescribed eradication therapy by their GP without further endoscopy. If dyspepsia recurred after eradication therapy, they would be referred to a gastroenterologist, who would perform an endoscopy to confirm the recurrence of ulceration. In this model, the expected total healthcare costs (i.e. the costs of drug acquisition and subsequent treatment when required) following prescription of eradication therapy were lower for OC (157 pounds) than for OA (173 pounds). New patients aged over 45 years would be referred for endoscopy because of the risk that dyspepsia might be the initial presentation of gastric cancer. If duodenal ulceration was found, eradication therapy would be prescribed and, if dyspepsia remained or recurred, the patient would be referred back to the gastroenterologist. In this case, it was considered unlikely that a further endoscopy would be performed. Thus, the healthcare costs associated with failure of eradication in these patients were less than for patients on maintenance treatment, and the expected total healthcare costs were higher for OC (349 pounds) than for OA (335 pounds). Finally, a new patient aged under 45 years with dyspepsia would have eradication therapy prescribed on the basis of a clinical diagnosis of duodenal ulcer plus serological evidence of infection with H. pylori. Continuation or recurrence of dyspepsia would result in referral to a gastroenterologist, who would perform an endoscopy. The total expected healthcare costs were higher for OC (253 pounds) than for OA (251 pounds). The cost effectiveness of OA was sensitive to changes in the default costs (i.e. the average costs from the survey used in the decision analysis), particularly in patients < 45 years old. In these patients, OC would become the cheaper option if amoxicillin were prescribed by brand name instead of in generic form. In this patient group, the outcome was crucially dependent on the accuracy of the clinical diagnosis of duodenal ulcer; if this was at least 60%, then OC would be the cheaper regimen. Overall, the model clearly shows that the higher drug cost of OC is likely to be substantially offset by savings in other healthcare costs. If the direct healthcare costs of OC are higher than OA, then the decision maker must consider the indirect and intangible costs associated with failure of eradication therapy.

Adult↗

PubMed2001

[Dental status and efficacy of Helicobacter pylori eradication].

Beside stomach Helicobacter pylori can colonize the oral cavity. One may think, therefore, that if H. pylori persists the eradication therapy in the oral cavity, it could infect the stomach again. Since in the oral cavity H. pylori occurs most frequently in a dental plaque gathering on teeth, the aim of the study was to investigate whether the natural teeth status is important for the efficacy of H. pylori eradication. The study was conducted on 45 peptic ulcer patients with natural teeth. They were eradicated with one of two regimens: 1/OAT-omeprazole (2 x 20 mg), amoxicillin (2 x 1000 mg), tinidazole (2 x 500 mg) (14-day course), 2/OAC-omeprazole (2 x 20 mg), amoxicillin (2 x 1000 mg), clarithromycin (2 x 250 mg) (7-day course). Dentistry examination was performed 4-6 weeks after the end of eradication therapy and consisted of determination of the number of teeth, caries index, dental treatment index, plaque index, and periodontal index. It was found that in successfully eradicated patients with OAT regimen, the number of teeth was higher and caries index lower than in those whose eradication therapy was unsuccessful; 24.8 +/- 5.2 vs 15.5 +/- 8.6 (p < 0.01) and 31.4% vs 46.0% (p < 0.01), respectively. The number of teeth and caries index were not associated with the efficacy of H. pylori eradication in OAC treated group. Irrespectively of the eradication regimen used, OAT or OAC, dental treatment index, plaque index, and periodontal index were not associated with the efficacy of H. pylori eradication. It is concluded that the natural teeth status may have influence on the outcome of H. pylori eradication. One should remember about this prescribing drugs for H. pylori eradication.

Adult↗

PubMed2003

13C-urea breath test to validate eradication of Helicobacter pylori in an Israeli population.

BACKGROUND: The 13C-urea breath test is the best non-invasive test to validate Helicobacter pylori eradication. Serology is unreliable for this purpose due to the slow and unpredictable decline in the antibody titer. OBJECTIVES: To characterize a specific group of patients who were treated for H. pylori and tested for successful eradication by 13C-UBT in our central laboratory, to correlate the eradication success rate with specific drug combinations, and to evaluate other factors that may influence eradication success. METHODS: 13C-UBT for H. pylori was performed in the central laboratory of Clalit Health Services. The breath test was performed by dedicated nurses in 25 regional laboratories and the samples were analyzed by a mass spectrometer (Analytical Precision 2003, UK). The physician who ordered the test completed a questionnaire computing demographic data (age, gender, origin), indication, use of non-steroidal anti-inflammatory drugs or proton pump inhibitor, and combination of eradication therapy. RESULTS: Of the 1,986 patients tested to validate successful H. pylori eradication, 539 (27%) had a positive test (treatment failure group) and 1,447 (73%) had a negative test (successful treatment group). Male gender, older age and European-American origin predicted better eradication rates. Dyspeptic symptoms and chronic PPI therapy predicted treatment failure. Combination therapy that included clarithromycin had a higher eradication rate than a combination containing metronidazole. The combination of omeprazole, amoxicillin and clarithromycin achieved an eradication rate of 81.3%, which was better than the combination of omeprazole, metronidazole and clarithromycin (77.2%) (not significant), or of omeprazole, amoxicillin and metronidazole (66.1%) (P < 0.01). CONCLUSION: Gender, age, origin, dyspepsia and PPI therapy may predict H. pylori eradication results. Our findings also support an increase in metronidazole resistance of H. pylori strains in Israel, as reported in other countries. We recommend combination therapy with omeprazole, amoxicillin and clarithromycin and avoidance of metronidazole as one of the first-line eradication drugs.

Adolescent↗

PubMed2003

[Eradication of Helicobacter pylori infection in Hungary (1993-2002): a meta-analysis].

INTRODUCTION: Meta-analysis is a useful tool in obtaining sound data in evidence-based medicine. The guidelines of eradication have been proposed in the I. Maastricht consensus (1996), which was modified in 2000. AIM OF STUDY: The scope of present paper is the meta-analysis of eradication studies performed in Hungary between 1993-2002. METHODS: Articles/abstracts dealing with eradication, published in peer-reviewed Hungarian and international journals, meetings of the Hungarian Society of Gastroenterology and its Endoscopic Section and international congresses were identified from major databases and by manual search. The data were classified into groups based on eradication schedules, type of antibiotic used, and provenience of the study. The pooled eradication rates were calculated and compared with the international data. RESULTS: The pooled eradication rate of proton pump inhibitor-based triple therapies was 82.9% (confidence interval: 72.1-93.7%); omeprazole, pantoprazole and lansoprazole-based therapies given b.i.d. were equally efficient. H2-blockers based triple combinations lasting 10-14 days obtained a pooled eradication rate of 86.3% (confidence interval: 72.2-99.8%), insignificantly higher (p = 0.07) than the rate obtained with proton pump inhibitors. Classical triple therapy's (bismuth + 2 antimicrobials) pooled eradication rate is significantly lower as that of proton pump inhibitor (p = 0.01) or H2 blocker-based combinations (p = 0.008). Clarithromycin, nitroimidazoles, amoxicillin and doxycyclin-based therapies obtained pooled eradication rates of 79.4%, 74.7%, 79.3% and 73.0%, respectively. The results obtained in randomized controlled trials and university centers were better than those achieved in county and urban hospitals. CONCLUSIONS: The results are in part contrasting with the recommendations of European and national consensus. Proton pump inhibitor-based triple regimens are proposed as first-line treatment, which is in agreement with our results, but H2-blockers based regimens seem to be of same efficacy in open studies, although these represent a lower level of evidence. Classical triple therapies, also recommended, did not reach acceptable rates of eradication. Antibiotic-based analysis did not reflect the local resistance profile. A multicenter, randomized Hungarian study is warranted to assess the real efficacy of the eradication schedules.

Academic Medical Centers↗

PubMed2004

[Evaluation of the efficacy of an Helicobacter pylori eradication treatment for idiopathic thrombocytopenic purpura patients].

The relationship between Helicobacter pylori (H. pylori) and gastric diseases (e.g. peptic ulcer, MALT lymphoma, and stomach cancer) has been widely accepted. Recent studies have also suggested an association between H. pylori infection and idiopathic thrombocytopenic purpura (ITP). In this study, an H. pylori eradication treatment was administered to 20 ITP patients and elucidated for its effectiveness. Among those 20 patients, H. pylori infection was confirmed in 17 (85%) through a C14 urea breath test, a rapid urease test, or a culture examination of a biopsied sample obtained by gastrointestinal endoscopy. Although the other 3 were negative to H. pylori, the H. pylori eradication treatment was also attempted because no other effective treatments had been established at the time of this study. In the H. pylori eradication treatment, lansoprazole (LPZ) 60 mg bid, amoxicillin (AMPC) 1500 mg bid, and clarithromycin (CAM) 400 mg bid were given to each patient for 7 days. For 4 cases, CAM was replaced with metronidazole (MNZ) 750 mg bid. The patients whose H. pylori infection was not eradicated after the first treatment received the re-eradication treatment with LPZ 60 mg bid, AMPC 1500 mg bid, and MNZ 750 mg bid for 7 days. After the treatments, the success of eradicating H. pylori was confirmed in all 17 H. pylori positive patients. In addition, platelet recovery was obtained in 11/20 patients (55%), which included 2 H. pylori negative patients and 2 patients whose H. pylori eradication was not successful after the first treatment. No relationship was found between the eradication effectiveness and the following clinical parameters: age, gender, previous therapies, disease duration, presence of anti-nucleus antibody, endoscopic atrophic change in the stomach, or kinds of antibiotics used for the treatment. These results support the efficacy of an H. pylori eradication treatment for ITP patients. A noteworthy result of this study was that an increase of platelet count was observed not only in H. pylori positive ITP patients, but also in 2 out of 3 H. pylori negative ITP patients after H. pylori eradication. Further studies are required to elucidate the efficacy of H. pylori eradication therapy in the patients negative for H. pylori.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2004

Eradication versus control: the economics of global infectious disease policies.

A disease is controlled if, by means of a public policy, the circulation of an infectious agent is restricted below the level that would be sustained by individuals acting independently to control the disease. A disease is eliminated if it is controlled sufficiently to prevent an epidemic from occurring in a given geographical area. Control and elimination are achieved locally, but a disease can only be eradicated if it is eliminated everywhere. Eradication is plainly a more demanding goal, but it has two advantages over control. First, the economics of eradication can be very favourable when eradication not only reduces infections but also avoids the need for vaccinations in future. Indeed, when eradication is feasible, it will either pay to control it to a fairly low level or to eradicate it. This suggests that, from an economics perspective, diseases that are eliminated in high-income countries are prime candidates for future eradication efforts. Second, the incentives for countries to participate in an eradication initiative can be strong; indeed they can be even stronger than an international control programme. Moreover, high-income countries typically benefit so much that they will be willing to finance elimination in developing countries. Full financing of an eradication effort by nation-states is not always guaranteed, but it can be facilitated by a variety of means. Hence, from the perspective of economics and international relations, eradication has a number of advantages over control. The implications for smallpox and polio eradication programmes are discussed.

Communicable Disease Control↗

PubMed2005

[Comparison of Helicobacter pylori eradication rate according to different PPI-based triple therapy--omeprazole, rabeprazole, esomeprazole and lansoprazole--].

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is an important cause of various gastrointestinal diseases. H. pylori eradication is essential for the cure and prevention of associated diseases. Nowdays, proton pump inhibitor (PPI)-based triple therapy is the standard eradication regimen. The aims of this study were to compare the H. pylori eradication rate of different PPI-based triple therapies and to find out the factors influencing the eradication rate. METHODS: From May 2002 through February 2004, H. pylori infected patients were treated with the eradication regimen based on one of the four PPIs (omeprazole, rabeprazole, esomeprazole and lansoprazole) for 1 or 2 weeks. After two weeks, drug compliance, adverse effects, and smoking history during the eradication therapy were obtained. The follow-up H. pylori test was performed 4 weeks after the completion of therapy. The data were analyzed by Chi-square test and multiple logistic regression analysis. RESULTS: Overall eradication rate was 83.5%. There was no significant difference in eradication rate among four PPIs (p=0.379). Odds ratio (OR) for omeprazole and rabeprazole was 1.15 (95% CI 0.50-2.68); for omeprazole and esomeprazole, OR 1.63 (95% CI 0.68-3.89); and for omeprazole and lansoprazole, OR 1.13 (95% CI 0.50-2.56). Smoking habit, site of ulcer, and the duration of therapy affected the eradication rate significantly. CONCLUSIONS: The efficacy of four different PPIs for H. pylori eradication is similar to each other. Smoking, site of ulcer, and the duration of treatment have significant effects on eradication rates.

Adult↗

PubMed2002

Does Helicobacter pylori eradication modify intestinal metaplasia evolution in the stomach?

BACKGROUND: We aimed to evaluate Helicobacter pylori eradication impact on the gastric carcinogenesis cascade following the evolution of intestinal metaplasia (IM) in gastric antrum after Helicobacter pylori (HP) eradication. METHODS: We followed yearly for a 5 year period after bacterial eradication, 69 HP positive patients with gastric or duodenal ulcers who showed antral gastric intestinal metaplasia at histology at time 0. All patients, eradicated by OAC triple short-term therapy and assessed both performing 13C-UBT 1 month after eradication and by Giemsa stain, persisted HP negative during follow-up. Upper endoscopy with 6 biopsies from gastric antrum at least 2 cm away from pylorus, was repeated every year in each patient involved in the study, in order to evaluate IM evolution and HP eradication persistence. During the follow-up histological specimens were examinated from the same pathologist and IM differentiated as complete (type I), incomplete (type II) or incomplete solphomucin-positive (type III). Statistical analysis between different groups after each year was performed by chi2 method. RESULTS: At time 0.48 cases out of 69 (69.7%) presented type I IM, 14 cases (20.2%) type II IM and 7 cases (10%) type III IM. IM presence in histological specimens after 1, 2, 3, 4 and 5 years from HP eradication were evaluated and statistical analysis between the 3 IM groups after each control showed a significant regression after HP eradication in type I versus III IM (p<0.001), mostly 2 and 3 years after HP eradication, but no significance in type I versus II IM (p=0.284) neither in type II versus III IM (p=0.981) also after 5 years. CONCLUSIONS: HP eradication permits complete intestinal metaplasia regression in gastric antrum 2 or 3 years after antibiotic treatment. Otherwise incomplete IM in gastric antrum, both type II and III, is not significantly modified after bacterial eradication.

Journal Article↗

PubMed2006

[Time course changes in morphological and functional characteristics of gastric mucosa after eradication of Helicobacter pylori in duodenal ulcers].

AIM: To study trends in morphological changes of gastric mucosa (GM) and its functional characteristics (serum gastrin-17, pepsinogens I and II) in eradication of Helicobacter pylori (HP) in patients with duodenal ulcer (DU). MATERIAL AND METHODS: HP infection was detected with a rapid urease test, morphological study of gastrobiopsies and polymerase chain reaction in 59 patients with DU. The results of HP eradication were assessed two months after the treatment. Morphological study of gastrobiopsies, assays for gastrin-17, pepsinogens I and II in blood serum were made before the treatment and one year after HP eradication. RESULTS: By the results of eradication two groups were formed: with effective eradication and uneffective eradication of H. pylori. Examination of GM one year after successful H. pylori eradication in DU patients GM inflammation relieved: reduction in polymorphonuclear (by 42.6%), mononuclear (by 29.3%) infiltration and number of lymphocytic follicules (16.8-fold). GM atrophy decreased by 47.8%. In patients with uneffective eradication the above positive changes were not registered. After H. pylori eradication, serum gastrin-17 lowered by 46. 7%, pepsinogen I--by 30.5%, pepsinogen II--by 36.9%. In uneffective eradication this decrease did not occur. CONCLUSION: H. pylori eradication leads to positive changes in morphological and functional indices reflecting GM condition.

Adult↗

PubMed1995

Cost-effectiveness of Helicobacter pylori eradication for the long-term management of duodenal ulcer in Canada.

BACKGROUND: A 1994 National Institutes of Health consensus panel recommended that eradication of Helicobacter pylori should be first-line therapy for persons with duodenal ulcer. OBJECTIVE: To assess the cost-effectiveness of H pylori eradication relative to alternative pharmacologic strategies in the long-term management of persons with confirmed duodenal ulcer. METHODS: Decision analysis model to estimate expected costs and symptomatic ulcer recurrences during a 12-month period for three general treatment strategies: (1) immediate H pylori eradication; (2) H pylori eradication at first ulcer recurrence; and (3) continuous maintenance therapy with a histamine2 receptor antagonist (ranitidine hydrochloride). Two H pylori eradication therapies were compared: classic triple therapy and omeprazole plus amoxicillin. Probabilities for ulcer recurrence are by meta-analysis of published randomized trials. Health care resources used in the management of duodenal ulcer recurrence were by expert physician panel. All costs are in 1993 Canadian dollars. RESULTS: Duodenal ulcer recurrence at 6 months (symptomatic and asymptomatic) with placebo was 65.4% and 12.8% with maintenance ranitidine therapy. Where eradication of H pylori was successful (85% of patients), the ulcer recurrence rate to 12 months was 3.7%. Treatment with ranitidine and triple therapy to eradicate H pylori on first presentation has an expected 1-year cost of $253 with 15 symptomatic recurrences per 100 patients; H pylori eradication by omeprazole plus amoxicillin had similar expected costs ($272) and outcomes (15 recurrences per 100 patients). Both of these early H pylori eradication strategies were dominant (less costly with same or better outcomes) over intermittent or continuous maintenance ranitidine therapy or delayed (after first recurrence) H pylori eradication. CONCLUSION: Our analysis provides economic evidence in support of the recent guidance that for persons with duodenal ulcer, early attempts to eradicate H pylori are recommended.

Canada↗

PubMed1996

Cost-effectiveness of Helicobacter pylori eradication therapy in duodenal ulcer disease.

A model analysis applied to Helicobacter pylori eradication found that, following successful healing with omeprazole and H. pylori eradication, virtually all patients were cured and experienced no relapse during the next 5 years. In contrast, almost all of the patients receiving episodic therapy relapsed and, during maintenance therapy with H2-receptor antagonists, most experienced at least one relapse. Although H. pylori eradication initially resulted in higher costs than the alternative therapies, it reduced the risk of recurrence and, for most patients, no future costs were incurred. Even with a worst case scenario, such as an H. pylori eradication rate of only 50%, the H. pylori eradication therapy had a pay-off period of less than 1.3 years compared with maintenance treatment and 3 years compared with episodic treatment. A preliminary analysis also compared the cost-effectiveness of three different H. pylori eradication therapies: omeprazole plus one or two antibiotics, ranitidine plus two antibiotics, and ranitidine plus bismuth triple therapy. The highest eradication rates (in excess of 90%) were achieved using 1-week regimens including omeprazole in combination with either clarithromycin or amoxycillin and a nitroimidazole. These regimens were also shown to be the most cost-effective. As the difference in costs between the therapies is small compared with the savings that can be achieved by successful H. pylori eradication, it is logical that the eradication strategy with the highest eradication rate is the most cost-effective. The model analysis concludes that H. pylori eradication in patients with duodenal ulcer disease is cost-effective in comparison to episodic therapy with omeprazole or maintenance therapy with ranitidine.

Anti-Bacterial Agents↗

PubMed1997

Helicobacter pylori eradication and antral intestinal metaplasia--two years follow-up study.

Intestinal metaplasia (IM) appears to be an important stage in the pathogenesis of intestinal type of gastric cancer. The purpose of the study was to evaluate how H. pylori eradication modifies IM in gastric antrum. 35 patients (19 M + 16 F) with peptic ulcer (28 duodenal ulcer +7 gastric ulcer) and antral IM with accompanying H. pylori infection proven by urease test and histological examination were followed-up after healing an ulcer achieved by 14 days treatment with 40 mg/d omeprazole and 2 g/d amoxicillin. Endoscopy examination was done every 4 months during 2 years after eradication. At least two antral biopsies were taken during each endoscopy. H. pylori eradication was achieved in 23 patients (66%). No reinfection was observed during the time of observation. The medium grade of intestinal metaplasia after eradication of H. pylori declined from 1.76 to 0.57 over the period of follow-up (p < 0.01). The difference became statistically significant from the 12 months after eradication. No significant change was seen in the group of non-eradicators (1.83 at the beginning of observation and 1.91 at the end point). Statistical difference between eradicators and non-eradicators was stated from the 12th month after eradication. Total regression of intestinal metaplasia was observed in 30% cases after one year and 61% cases after two years after H. pylori eradication. The cure of H. pylori infection significantly reduces the presence of antral IM. Regression of IM appears to be a long-term process taking many months after H. pylori eradication.

Adult↗

PubMed2002

Eradication of Helicobacter pylori infection induces an increase in body mass index.

BACKGROUND: The relationship between H. pylori infection and body mass indices is controversial. AIM: To investigate the relationship between H. pylori infection and body indices, and to examine the effect of H. pylori eradication therapy on body indices. METHODS: Nine-hundred and thirty-two employees of an industrial corporation were examined for H. pylori infection and body mass indices. Three hundred and two H. pylori-positive cases diagnosed with chronic gastritis by upper gastrointestinal endoscopy or radiography underwent eradication therapy. Body mass indices, serum total cholesterol levels and symptom scores were obtained before and at 12 months after eradication therapy. RESULTS: There was no significant difference in body weight, body mass index (BMI) or serum total cholesterol level between the H. pylori-positive and H. pylori-negative groups. However, body weight and BMI increased significantly 12 months after eradication of H. pylori infection. In contrast, there was no significant difference in body weight and BMI 12 months after eradication therapy in the non-eradication group. Serum total cholesterol levels did not change after eradication therapy in either the eradication or non-eradication groups. CONCLUSION: Eradication of H. pylori infection induced an increase in BMI in industrial workers with chronic gastritis in Japan.

Adult↗

PubMed1996

Review article: clinical aspects of Helicobacter pylori eradication therapy in peptic ulcer disease.

BACKGROUND AND AIMS: Although the role of H. pylori in peptic ulcer disease is no longer in dispute, certain aspects of eradication therapy in this condition have yet to be settled. Uncertainties still surround the relationship between Helicobacter pylori status and ulcer healing, the efficacy of eradication therapy in alleviating acute symptoms and healing ulcers, and the prognosis after eradication with respect to recurrence of symptoms, ulcers and complications. The present literature review, encompassing studies published up to October 1995, specifically addresses these issues. RESULTS: Pooled data show that eradication therapy heals > or = 90% of duodenal ulcers and > or = 85% of gastric ulcers, while individual studies repeatedly confirm that it is more effective at healing ulcers than conventional treatment with anti-secretory drugs. Recent reports indicate that triple therapy regimens for 1 week, provided they include an anti-secretory drug, are sufficient to achieve high rates of healing and rapid symptom relief. A detailed analysis of the data, particularly those from studies reporting healing rates in relation to H. pylori status after eradication therapy, provides strong evidence that eradication of H. pylori produces ulcer healing. Follow-up studies show that ulcer recurrence and complications are rare after eradication treatment in patients with either gastric or duodenal ulcer disease. However, while ulcer symptoms are infrequent during follow-up, a proportion of patients appear to develop gastrooesophageal reflux after eradication. CONCLUSIONS: H. pylori eradication is highly effective in promoting ulcer healing and preventing subsequent ulcer recurrence. These beneficial effects of eradication therapy are observed in patients with either gastric or duodenal ulcers which are associated with H. pylori infection.

Anti-Bacterial Agents↗

PubMed2005

Helicobacter felis eradication restores normal architecture and inhibits gastric cancer progression in C57BL/6 mice.

BACKGROUND & AIMS: The impact of Helicobacter eradication therapy on the progression or regression of gastric lesions is poorly defined. This study examined the effects of eradication therapy on inflammation, atrophy, metaplasia, dysplasia, and cancer progression. METHODS: C57BL/6 mice were infected with Helicobacter felis and received bacterial eradication therapy after 2, 6, or 12 months of infection. The gastric mucosa was examined at early, mid, and late intervals after eradication and graded for histology, expression pattern of alpha-catenin and beta-catenin, and IQGAP1. RESULTS: Eradication of Helicobacter infection after 2 or 6 months of infection led to a regression of inflammation, restoration of parietal cell mass, and reestablishment of normal architecture. Progression to adenocarcinoma was prevented. Bacterial eradication at 1 year was associated with the reappearance of parietal cells, partial regression of inflammation, and restoration of architecture. Hyperplasia scores significantly improved, and dysplasia did not progress. Infected mice developed antral adenocarcinoma and gastric outlet obstruction by 24 months. Only 30% of the mice receiving bacterial eradication therapy at 12 months developed antral carcinoma. Bacterial eradication at any time during the first year of infection prevented death due to gastric outlet obstruction. The expression pattern of alpha-catenin, beta-catenin, and IQGAP1 varied with cell type and paralleled histologic changes. CONCLUSIONS: Inflammation, metaplasia, and dysplasia are reversible with early eradication therapy; progression of dysplasia was arrested with eradication therapy given as late as 1 year and prevented gastric cancer-related deaths.

Adenocarcinoma↗

PubMed2001

Eradication of Helicobacter pylori restores the inhibitory effect of cholecystokinin on gastric motility in duodenal ulcer patients.

BACKGROUND: Increased gastric emptying and defective action of endogenous cholecystokinin (CCK), that is known to inhibit this emptying, have been implicated in the pathogenesis of duodenal ulcer (DU). The aim of this double blind study was to assess whether CCK and somatostatin participate in the impairment of gastric motility in active DU patients before and after Helicobacter pylori eradication. METHODS: Tests were undertaken in 10 DU patients without or with elimination of the action of endogenous CCK using loxiglumide, a selective CCK-A receptor antagonist, before and 4 weeks after eradication of H. pylori with 1 week triple therapy that resulted in healing of all DUs tested. The gastric emptying rate after feeding was determined using the 13C-acetate breath test. Before each test, samples of gastric juice were obtained by aspiration using a nasogastric tube for determination of somatostatin using specific radioimmunoassay. RESULTS: Prior to H. pylori eradication gastric emptying half-time was 31 +/- 6 min in placebo-treated DU patients and this emptying rate was not significantly affected in tests after pretreatment with loxiglumide (10 mg/kg i.v.). Following eradication of H. pylori, in tests with placebo gastric emptying half-time was significantly longer (48 +/- 9 min) compared to that prior to H. pylori eradication. Pretreatment with loxiglumide in H. pylori eradicated DU patients significantly enhanced the gastric emptying rate with an emptying half-time of only 33 +/- 4 min. Eradication of H. pylori resulted in a significant increase in somatostatin concentration in gastric juice and loxiglumide significantly reduced this luminal somatostatin in H. pylori-eradicated subjects compared to values before anti-H. pylori therapy. CONCLUSIONS: 1) H. pylori infection in DU patients is accompanied by enhanced gastric emptying and reduction in luminal release of somatostatin; 2) the failure of loxiglumide to affect gastric emptying in H. pylori-infected DU patients might be attributed, at least in part, to the failure of endogenous CCK to control gastric motility due to deficient release of somatostatin; and 3) H. pylori-infected patients appear to exhibit a deficient somatostatin release by endogenous CCK that can be reversed by the eradication of H. pylori indicating that both CCK and somatostatin may contribute to normalization of gastric emptying following H. pylori eradication in DU patients.

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