SBV Journal of Basic, Clinical and Applied Health Science

Register      Login

VOLUME 2 , ISSUE 3 ( July–September, 2019 ) > List of Articles

Original Article

Comparative Study between Two Triple-therapy Regimens in Treating Helicobacter pylori: Related Peptic Ulcer Disease

Gokul D Yatheendranathan, Sudhakar Ankaiya, J Lalith Kumar

Keywords : Comparison, Endoscopy, Helicobacter pylori, Triple-therapy

Citation Information : Yatheendranathan GD, Ankaiya S, Kumar JL. Comparative Study between Two Triple-therapy Regimens in Treating Helicobacter pylori: Related Peptic Ulcer Disease. 2019; 2 (3):108-111.

DOI: 10.5005/jp-journals-10082-02222

License: CC BY-NC 4.0

Published Online: 18-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: Helicobacter pylori (H. pylori) infection has increased worldwide and it is found to be positive in more than 50% of the specimens taken during endoscopy. The goal of the study is to compare the efficacy of two triple-therapy regimens in eradication of H. pylori and to evaluate the cost factor involved. Aims: • To compare and study between two triple-therapy regimens in treating (H. pylori)-related peptic ulcer disease. • To find the cost efficacy between two triple-therapy regimens. Materials and methods: A randomized single-blinded study was conducted at a tertiary care hospital from 2016 to 2018. Upper gastrointestinal endoscopy was performed on all the patients after spraying them with a topical local anesthetic agent (10% lignocaine spray). Two biopsy specimens were taken from the antrum of the stomach. The rapid urease test (RUT) was considered positive, if a color change from yellow to pink was noted in the RUT kit within 10 minutes. The sample size was calculated and fixed at 60. The RUT-positive patients were divided into two groups by computer-generated random allotment. Group I patients were started on regimen I comprising omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, and amoxicillin 1,000 mg twice daily for 2 weeks. Group II patients were started on regimen II: OCM: omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, and metronidazole 400 mg twice daily for 2 weeks. The endoscopic RUT was performed in the beginning and after 6 weeks to check for eradication of H. pylori. The ethical committee approval was obtained (IEC no. 2017/308) and data were collected using a proforma and were entered in the Excel sheet. The statistical analysis was done by SPSS (version 23). Descriptive statistics regarding age, sex, and inference with regimens were calculated and recorded. Results: Among the patients administered regimen I, H. pylori was eradicated in 27 (90%). And among the patients administered regimen II, H. pylori was eradicated in 28 (93.3%). This difference was not statistically significant with p value of 0.323. However, it was observed that regimen II was cheaper than regimen I.


HTML PDF Share
  1. WHO. Helicobacter pylori [Internet]. WHO. World Health Organization; 2013.
  2. Atherton JC. The pathogenesis of Helicobacter pylori–induced gastro-duodenal diseases. Annu Rev Pathol Mech Dis 2006;1(1):63–96. DOI: 10.1146/annurev.pathol.1.110304.100125.
  3. Kusters JG, van Vliet AHM, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev 2006;19(3):449–490. DOI: 10.1128/CMR.00054-05.
  4. Wu C, Kuo KN, Wu M, Chen Y, Wang C, Lin J. Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease. Gastroenterology 2009;137(5):1641–1648.e2. DOI: 10.1053/j.gastro.2009.07.060.
  5. Kale-Pradhan PB, Landry HK, Sypula WT. Esomeprazole for acid peptic disorders. Ann Pharmacother 2002;36(4):655–663. DOI: 10.1345/aph.1A104.
  6. Johnson DA. Review of esomeprazole in the treatment of acid disorders. Expert Opin Pharmacother 2003;4(2):253–264. DOI: 10.1517/14656566.4.2.253 Johnson TJ, Hedge DD. Esomeprazole: a clinical review. Am J Health Syst Pharm 2002;59(14):1333–1339.
  7. Scott LJ, Dunn CJ, Mallarkey G, Sharpe M. Esomeprazole: a review of its use in the management of acid-related disorders. Drugs 2002;62(10):1503–1538. DOI: 10.2165/00003495-200262100-00006.
  8. Spencer CM, Faulds D. Esomeprazole. Drugs 2000;60(2):321–329. DOI: 10.2165/00003495-200060020-00006discussion 330-1.
  9. Gisbert JP. Potent gastric acid inhibition in Helicobacter pylori eradication. Drugs 2005;65(Suppl. 1):83–96. DOI: 10.2165/00003495-200565001-00012.
  10. Röhss K, Hasselgren G, Hedenström H. Effect of esomeprazole 40 mg vs omeprazole 40 mg on 24-hour intragastric pH in patients with symptoms of gastroesophageal reflux disease. Dig Dis Sci 2002;47(5):954–958. DOI: 10.1023/a:1015009300955.
  11. Kahrilas PJ, Falk GW, Johnson DA, Schmitt C, Collins DW, Whipple J, et al. Esomeprazole improves healing and symptom resolution as compared with Omeprazole in reflux oesophagitis patients: a randomized controlled trial. The esomeprazole study investigators. Aliment Pharmacol Ther 2000;14(10):1249–1258. DOI: 10.1046/j.1365-2036.2000.00856.x.
  12. Lind T, Rydberg L, Kylebäck A, Jonsson A, Andersson T, Hasselgren G, et al. Esomeprazole provides improved acid control vs. Omeprazole in patients with symptoms of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2000;14(7):861–867. DOI: 10.1046/j.1365-2036.2000.00813.x.
  13. Gatta L, Perna F, Figura N, Ricci C, Holton J, D’anna L, et al. Antimicrobial activity of esomeprazole versus Omeprazole against Helicobacter pylori. J Antimicrob Chemother 2003;51(2):439–442. DOI: 10.1093/jac/dkg085.
  14. Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III consensus report. Gut 2007;56(6):772–781. DOI: 10.1136/gut.2006.101634.
  15. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon ATR, Bazzoli F, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut [Internet] 2012;61(5):646–664. DOI: 10.1136/gutjnl-2012-302084.
  16. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut [Internet] 2017;66(1):6–30. DOI: 10.1136/gutjnl-2016-312288.
  17. Khanal S, Rao BS, Sharma Y, Khan GM, Makaju R. Comparative study between two triple therapy regimens on eradication of Helicobacter pylori (hp). Kathmandu University Journal Of Science, Engineering and Technology, vol. I; 2005.
  18. Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology 2016;151(1):51–69.e14. DOI: 10.1053/j.gastro.2016.04.006.
  19. Molina-Infante J, Lucendo AJ, Angueira T, Rodriguez-Tellez M, Perez-Aisa A, Balboa A, et al. Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study. Aliment Pharmacol Ther 2015;41(6):581–589. DOI: 10.1111/apt.13069.
  20. Alsohaibani F, Al Ashgar H, Al Kahtani K, Kagevi I, Peedikayil M, Alfadda A, et al. Prospective trial in Saudi Arabia comparing the 14-day standard triple therapy with the 10-day sequential therapy for treatment of Helicobacter pylori infection. Saudi J Gastroenterol 2015;21(4):220–225. DOI: 10.4103/1319-3767.161647.
  21. Nyssen OP, McNicholl AG, Megraud F, Savarino V, Oderda G, Fallone CA, et al. Sequential versus standard triple first-line therapy for Helicobacter pylori eradication. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2016.
  22. Yang J-C, Lin C-J, Wang H-L, Chen J-D, Kao JY, Shun C-T, et al. High-dose dual therapy is superior to standard first-line or rescue therapy for Helicobacter pylori infection. Clin Gastroenterol Hepatol 2015;13(5):895–905.e5. DOI: 10.1016/j.cgh.2014.10.036.
  23. Kim SE, Park MI, Park SJ, Moon W, Choi YJ, Cheon JH, et al. Trends in Helicobacter pylori eradication rates by first-line triple therapy and related factors in eradication therapy. Korean J Intern Med 2015;30(6):801–807. DOI: 10.3904/kjim.2015.30.6.801.
  24. Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut 2016;65(9):1439–1446. DOI: 10.1136/gutjnl-2015-311304.
  25. Dore MP, Lu H, Graham DY. Role of bismuth in improving Helicobacter pylori eradication with triple therapy. Gut 2016;65(5):870–878. DOI: 10.1136/gutjnl-2015-311019.
  26. Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ 2014;348(may20 1):g3174. DOI: 10.1136/bmj.g3174.
  27. Zhang M-M, Qian W, Qin Y-Y, He J, Zhou Y-H. Probiotics in Helicobacter pylori eradication therapy: a systematic review and meta-analysis. World J Gastroenterol 2015;21(14):4345–4357. DOI: 10.3748/wjg.v21.i14.4345.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.