Improving the standard sequential treatment of Helicobacter pylori with either extended treatment or by adding bismuth

Publication date: Available online 19 May 2017
Source:Arab Journal of Gastroenterology
Author(s): Zehra Akpinar, Sinan Akay, Belkis Unsal
Background and study aimsStandard sequential treatment for Helicobacter pylori (H. pylori) eradication has less success because of increasing clarithromycin resistance. Extended treatment and bismuth containing regimens were, therefore, investigated.Patients and methodsConsecutive H. pylori-positive patients with dyspepsia were randomly allocated to one of the three sequential regimens: The first group was given lansoprazole 30mg b.i.d. plus amoxicillin 1g b.i.d. for the first 5days, followed by lansoprazole 30mg b.i.d., clarithromycin 500mg b.i.d., and metronidazole 500mg t.i.d. for the second 5days (standard sequential, SS). The second group was given the same regimen but for 7+7days instead of 5+5days (extended sequential, ES). In the third group, colloidal bismuth 600mg b.i.d. was added to the second regimen for 14days (extended sequential+bismuth subcitrate, ES+B). Urea breath test or histology was performed before enrolment and 6weeks after the end of treatment to detect H. pylori.ResultsA total of 280 patients were included in the study. Per-protocol eradication rates were 62% (56/90), 72% (56/78), and 75% (54/72) in patients who received SS, ES, and ES+B regimens, respectively. Moreover, intention-to-treat eradication rates were 53% (56/104), 62% (56/90) and 62% (54/86), respectively. The differences in eradication rates between the groups were not statistically significant.ConclusionAlthough prolonging of the sequential treatment to 14days may be considered, addition of bismuth to the regimen is of no avail.



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