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Panminerva Medica 2002 June;44(2):145-7

lingua: Inglese

Eradication of Helicobacter pylori infection with proton pump inhibitor-based triple therapy. A randomised study

Palmas F., Pellicano R., Massimetti E., Berrutti M., Fagoonee S. *, Rizzetto M.

From the UOA­DU Gastro-Hepatology Ospedale S. Giovanni Battista (Molinette), Torino
*Department of Genetics, Biology and Biochemistry University of Turin, Turin, Italy


Background. Helicobacter pylo­ri (H. pylo­ri) infec­tion ­plays an impor­tant ­role in the path­o­gen­e­sis of duod­en­al ­ulcer (DU) dis­ease. Low DU recur­renc­es and rein­fec­tion ­rates ­were uni­ver­sal­ly ­described, ­when treat­ment was effec­tive. It has ­been sug­gest­ed ­that ­short-­term ­triple ther­a­py, com­pris­ing a pro­ton ­pump inhib­i­tor ­plus 2 anti­bi­o­tics (cla­rith­rom­y­cin, amox­y­cil­lin or a nitro­imid­a­zole), ­should be ­used as ­first ­choice in treat­ing H. pylo­ri infec­tion. Nevertheless, con­flict­ing ­results ­have ­been report­ed on ­using ­these treat­ment reg­i­mens in dif­fer­ent coun­tries. Our aim was to com­pare ­cure ­rates of H. pylo­ri infec­tion, ­with a 1-­week ­triple ther­a­py ver­sus 10 and 15 day ­triple sched­ules, in ­patients ­with DU.
Meth­ods. A ­total of 172 ­patients (91 ­males, ­mean age 56.2± 3.2 ­years) ­were ran­dom­ly treat­ed ­with a ­triple ther­a­py includ­ing a stan­dard ­dose of pro­ton ­pump inhib­i­tor, amox­i­cil­lin at a ­dose of 1 g ­twice dai­ly and cla­rith­rom­y­cin ­500 mg twice a day. Sixty-six ­patients ­received a 1-­week ­triple ther­a­py (group I), 42 sub­jects ­were treat­ed ­with a 10-day ­triple ther­a­py (group II) and 64 oth­ers ­with a 14-day ­triple ther­a­py (group III). H. pylo­ri infec­tion at ­entry and after erad­i­ca­tion, at ­least 4 ­weeks ­after ther­a­py had end­ed, ­were ­assessed by 13C ­urea ­breath ­test and his­tol­o­gy on biop­sies ­from the ­antrum and the cor­pus.
Results. At the end of the ­course of treat­ment, the over­all H. pylo­ri erad­i­ca­tion ­rate was 68.2% (45/66) in ­group I, 76.2% (32/42) in ­group II and 71.9% (46/64) in ­group III, with­out any sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­ence ­between the 3 dif­fer­ing peri­od reg­i­mens, ­although a ­trend for bet­ter ­results ­with the 10-­day ­triple ther­a­py was ­observed. Compliance was ­good and ­side ­effects infre­quent and ­mild.
Conclusions. None of the 3 peri­ods of ­triple ther­a­py ­achieved 80% erad­i­ca­tion ­rate rec­om­mend­ed by the Maastricht Consen-sus Conference. The 10-day ­triple ther­a­py, ­although not sig­nif­i­cant­ly, pro­vid­ed a sat­is­fac­to­ry treat­ment ­against H. pylo­ri infec­tion.

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