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Changes in 12-Year First-Line Eradication Rate of Helicobacter pylori Based on Triple Therapy with Proton Pump Inhibitor, Amoxicillin and Clarithromycin.

Sasaki M, Ogasawara N, Utsumi K, Kawamura N, Kamiya T, Kataoka H, Tanida S, Mizoshita T, Kasugai K, Joh T - J Clin Biochem Nutr (2010)

Bottom Line: Primary resistance to CAM rose significantly over time from 8.7% to 23.5%, 26.7% and 34.5% while the eradication rate decreased significantly from 90.6% to 80.2%, 76.0% and 74.8%.A decrease in the H. pylori eradication rate after triple therapy using a PPI + AMPC + CAM has been acknowledged, and an increase in CAM resistance is considered to be a factor.From now on, a first-line eradication regimen that results in a higher eradication rate ought to be investigated.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho, Nagoya 467-8601, Japan.

ABSTRACT
A triple therapy based on a proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) is recommended as a first-line therapy for Helicobacter pylori (H. pylori) eradication and is widely used in Japan. However, a decline in eradication rate associated with an increase in prevalence of CAM resistance is viewed as a problem. We investigated CAM resistance and eradication rates over time retrospectively in 750 patients who had undergone the triple therapy as first-line eradication therapy at Nagoya City University Hospital from 1995 to 2008, divided into four terms (Term 1: 1997-2000, Term 2: 2001-2003, Term 3: 2004-2006, Term 4: 2007-2008). Primary resistance to CAM rose significantly over time from 8.7% to 23.5%, 26.7% and 34.5% while the eradication rate decreased significantly from 90.6% to 80.2%, 76.0% and 74.8%. Based on the PPI type, significant declines in eradication rates were observed with omeprazole or lansoprazole, but not with rabeprazole. A decrease in the H. pylori eradication rate after triple therapy using a PPI + AMPC + CAM has been acknowledged, and an increase in CAM resistance is considered to be a factor. From now on, a first-line eradication regimen that results in a higher eradication rate ought to be investigated.

No MeSH data available.


Primary CAM resistance rose significantly from 8.7% (1997–2000) to 23.5% (2001–2003), 26.7% (2004–2006), and 34.4% (2007–2008).
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Figure 2: Primary CAM resistance rose significantly from 8.7% (1997–2000) to 23.5% (2001–2003), 26.7% (2004–2006), and 34.4% (2007–2008).

Mentions: Table 1 presents the patients’ background in this study. 491 men and 259 women with the average age of 56.1 ± 14.2 years were enrolled in the study. The classification of disorders were gastric ulcers (258/750, 34.4%), duodenal ulcers (188/750 25.1%), gastroduodenal ulcers (57/750, 7.6%), other gastrointestinal disorders (247/750, 32.9%). The patients with gastrointestinal disorders mainly comprised patients with atrophic gastritis or patients having undergone endoscopic treatment for a gastric tumor. 41 patients did not visit for the evaluation of H. pylori eradication. 709 patients were tested by UBT to determine whether the H. pylori was eradicated, and successful eradication was assessed in 559 of these patients. We divided the study into the four terms of 1997 to 2000 (Term 1), before H. pylori eradication therapy was indicated and covered by insurance in Japan; the first half of the period from 2001 to 2006, when eradication therapy was based on OPZ and LPZ (Term 2, from 2001 to 2003); and the second half of that (2004–2006, Term 3); and 2007 and later years (Term 4), when treatment with RPZ was approved for insurance coverage. There were no differences based on gender or type of disorder from Term 1 to Term 4, but the ages were significantly higher in Terms 3 and 4 compared it in Term 1. Eradication rates significantly declined over time from 90.6% to 80.2%, 76.0% and 74.8% between Term 1 and Term 4 (Fig. 1). On the other hand, primary CAM resistance rose significantly over time between 1997 and 2008 from 8.7% in Term 1, prior to 2000; 23.5% in Term 2; 26.7% in Term 3; and 34.5% in Term 4 (Fig. 2). In 159 patients who were tested for CAM susceptibility, the eradication rate in those with CAM susceptibility was 86.7% while the eradication rate in those with CAM-resistant bacteria was 25.0%, which resulted in a significant difference. Therefore, the rise in primary CAM resistance is considered to be a major factor leading the decline in the first-line eradication rate based on triple therapy with the PPI, AMPC, and CAM. We also investigated the differences over time in the eradication rate for the different types of PPIs. RPZ was not used for eradication treatment from 2000, when eradication therapy was approved in Japan, until 2007, when RPZ was approved for insurance coverage. Therefore, we compared the eradication rates by RPZ for Term 1 with Term 4. For OPZ and LPZ, eradication rates were compared in all four terms. A significant decline over time in eradication rates by OPZ/LPZ from Terms 1 to Term 4 was observed; 91.2%, 80.2%, 76.0% and 69.0%. On the other hand, no significant difference was found in the RPZ eradication rates; 89.2% in Term 1 and 79.4% in Term 4 (Fig. 3).


Changes in 12-Year First-Line Eradication Rate of Helicobacter pylori Based on Triple Therapy with Proton Pump Inhibitor, Amoxicillin and Clarithromycin.

Sasaki M, Ogasawara N, Utsumi K, Kawamura N, Kamiya T, Kataoka H, Tanida S, Mizoshita T, Kasugai K, Joh T - J Clin Biochem Nutr (2010)

Primary CAM resistance rose significantly from 8.7% (1997–2000) to 23.5% (2001–2003), 26.7% (2004–2006), and 34.4% (2007–2008).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2901764&req=5

Figure 2: Primary CAM resistance rose significantly from 8.7% (1997–2000) to 23.5% (2001–2003), 26.7% (2004–2006), and 34.4% (2007–2008).
Mentions: Table 1 presents the patients’ background in this study. 491 men and 259 women with the average age of 56.1 ± 14.2 years were enrolled in the study. The classification of disorders were gastric ulcers (258/750, 34.4%), duodenal ulcers (188/750 25.1%), gastroduodenal ulcers (57/750, 7.6%), other gastrointestinal disorders (247/750, 32.9%). The patients with gastrointestinal disorders mainly comprised patients with atrophic gastritis or patients having undergone endoscopic treatment for a gastric tumor. 41 patients did not visit for the evaluation of H. pylori eradication. 709 patients were tested by UBT to determine whether the H. pylori was eradicated, and successful eradication was assessed in 559 of these patients. We divided the study into the four terms of 1997 to 2000 (Term 1), before H. pylori eradication therapy was indicated and covered by insurance in Japan; the first half of the period from 2001 to 2006, when eradication therapy was based on OPZ and LPZ (Term 2, from 2001 to 2003); and the second half of that (2004–2006, Term 3); and 2007 and later years (Term 4), when treatment with RPZ was approved for insurance coverage. There were no differences based on gender or type of disorder from Term 1 to Term 4, but the ages were significantly higher in Terms 3 and 4 compared it in Term 1. Eradication rates significantly declined over time from 90.6% to 80.2%, 76.0% and 74.8% between Term 1 and Term 4 (Fig. 1). On the other hand, primary CAM resistance rose significantly over time between 1997 and 2008 from 8.7% in Term 1, prior to 2000; 23.5% in Term 2; 26.7% in Term 3; and 34.5% in Term 4 (Fig. 2). In 159 patients who were tested for CAM susceptibility, the eradication rate in those with CAM susceptibility was 86.7% while the eradication rate in those with CAM-resistant bacteria was 25.0%, which resulted in a significant difference. Therefore, the rise in primary CAM resistance is considered to be a major factor leading the decline in the first-line eradication rate based on triple therapy with the PPI, AMPC, and CAM. We also investigated the differences over time in the eradication rate for the different types of PPIs. RPZ was not used for eradication treatment from 2000, when eradication therapy was approved in Japan, until 2007, when RPZ was approved for insurance coverage. Therefore, we compared the eradication rates by RPZ for Term 1 with Term 4. For OPZ and LPZ, eradication rates were compared in all four terms. A significant decline over time in eradication rates by OPZ/LPZ from Terms 1 to Term 4 was observed; 91.2%, 80.2%, 76.0% and 69.0%. On the other hand, no significant difference was found in the RPZ eradication rates; 89.2% in Term 1 and 79.4% in Term 4 (Fig. 3).

Bottom Line: Primary resistance to CAM rose significantly over time from 8.7% to 23.5%, 26.7% and 34.5% while the eradication rate decreased significantly from 90.6% to 80.2%, 76.0% and 74.8%.A decrease in the H. pylori eradication rate after triple therapy using a PPI + AMPC + CAM has been acknowledged, and an increase in CAM resistance is considered to be a factor.From now on, a first-line eradication regimen that results in a higher eradication rate ought to be investigated.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho, Nagoya 467-8601, Japan.

ABSTRACT
A triple therapy based on a proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) is recommended as a first-line therapy for Helicobacter pylori (H. pylori) eradication and is widely used in Japan. However, a decline in eradication rate associated with an increase in prevalence of CAM resistance is viewed as a problem. We investigated CAM resistance and eradication rates over time retrospectively in 750 patients who had undergone the triple therapy as first-line eradication therapy at Nagoya City University Hospital from 1995 to 2008, divided into four terms (Term 1: 1997-2000, Term 2: 2001-2003, Term 3: 2004-2006, Term 4: 2007-2008). Primary resistance to CAM rose significantly over time from 8.7% to 23.5%, 26.7% and 34.5% while the eradication rate decreased significantly from 90.6% to 80.2%, 76.0% and 74.8%. Based on the PPI type, significant declines in eradication rates were observed with omeprazole or lansoprazole, but not with rabeprazole. A decrease in the H. pylori eradication rate after triple therapy using a PPI + AMPC + CAM has been acknowledged, and an increase in CAM resistance is considered to be a factor. From now on, a first-line eradication regimen that results in a higher eradication rate ought to be investigated.

No MeSH data available.