Helicobacter pylori (Hp) infection is highly prevalent in many countries and may cause gastritis, peptic ulcer disease, gastric cancer, and lymphoma. Successful eradication depends on the specific treatment used, pati...Helicobacter pylori (Hp) infection is highly prevalent in many countries and may cause gastritis, peptic ulcer disease, gastric cancer, and lymphoma. Successful eradication depends on the specific treatment used, patient compliance, and Hp antibiotic resistance. The primary aim was to characterize groups of patients with one or more failures of Hp eradication treatment. The secondary aim was to evaluate the factors that influence eradication failure. Between April 1, 1998, and December 31, 2001, 5885 patients were studied for the success of Hp eradication with the 13C- urea breath test ( 13C- UBT): 5442 after one course of treatment (Group I), 380 after two courses (Group II), and 63 after three courses (Group Ⅲ ). The 13C- UBT was positive in 27.8% , 37.4% , and 47.6% of patients in Groups Ⅰ , Ⅱ , and Ⅲ , respectively (PI- II = 0.000, PⅡ - Ⅲ = 0.126). A combination of omeprazole, amoxicillin, and clarithromycin (OAC) was used in 31.3% , 27.4% , and 7.9% of Groups I, Ⅱ , and Ⅲ , respectively, and a combination of omeprazole, amoxicillin, and metronidazole (OAM) in 15.2% , 28.9% , and 28.6% , respectively. Regimens that contained clarithromycin were used in decreasing order in Groups Ⅰ , Ⅱ , and Ⅲ , and regimens containing metronidazole, bismuth, or tetracycline, in increasing order. The only good prognostic factor for successful eradication was Israeli origin, while European- American and Asian- African origin, recurrence of symptoms, a history of duodenal ulcer, and chronic proton pump inhibitor (PPI) use did not favor successful eradication. Our results suggest that origin, history of peptic disease, and chronic PPI use are predictors of eradication failure.展开更多
Triple therapy with a proton pump inhibitor (PPI), amoxicillin, and clarithrom ycin is widely accepted for Helicobacter pylori eradication. The choice of PPI for triple therapy in Israel is arbitrary, with no preferen...Triple therapy with a proton pump inhibitor (PPI), amoxicillin, and clarithrom ycin is widely accepted for Helicobacter pylori eradication. The choice of PPI for triple therapy in Israel is arbitrary, with no preference for any one PPI exc ept for economic considerations. Direct comparison between omeprazole and lansop razole for efficacy of H. pylori eradication has never been performed in an Isra eli poplulation. Based on the pharmacokinetic data, lansoprazole-based therapy may be a better alternative than omeprazole-based therapy. The aim of this study was to compare the effectiveness of triple therapy regimens with omeprazole (L osec, AstraZeneca; or Omeradex, Dexxon) or lansoprazole (TAP Pharmaceuticals) in eradicating H. pylori infection. The database of the biggest health insurance p rovider in Israel was reviewed for all patients who received 1 week of treatment with omeprazole (n = 1293) or lansoprazole (n = 85) with additional amoxicillin and clarithromycin for H. pylori eradication in 2002. All patients underwent th e 13C-urea breath test (13CUBT) for validation of eradication. A negative 13CUB T result was noted in 1026 of the patients treated with omeprazole (79.4%) and 61 treated with lansoprazole (71.8%). On logistic regression analysis, none of the confounding factors (sex, age, indication, chronic use of PPI, eradication p rotocol) were found to contribute to the discrimination between a negative (succ essful eradication) and a positive (failed eradication) 13CUBT. There is no stat istically significant difference between omeprazole and lansoprazole as part of a PPI-based triple therapy for eradication of H. pylori.展开更多
文摘Helicobacter pylori (Hp) infection is highly prevalent in many countries and may cause gastritis, peptic ulcer disease, gastric cancer, and lymphoma. Successful eradication depends on the specific treatment used, patient compliance, and Hp antibiotic resistance. The primary aim was to characterize groups of patients with one or more failures of Hp eradication treatment. The secondary aim was to evaluate the factors that influence eradication failure. Between April 1, 1998, and December 31, 2001, 5885 patients were studied for the success of Hp eradication with the 13C- urea breath test ( 13C- UBT): 5442 after one course of treatment (Group I), 380 after two courses (Group II), and 63 after three courses (Group Ⅲ ). The 13C- UBT was positive in 27.8% , 37.4% , and 47.6% of patients in Groups Ⅰ , Ⅱ , and Ⅲ , respectively (PI- II = 0.000, PⅡ - Ⅲ = 0.126). A combination of omeprazole, amoxicillin, and clarithromycin (OAC) was used in 31.3% , 27.4% , and 7.9% of Groups I, Ⅱ , and Ⅲ , respectively, and a combination of omeprazole, amoxicillin, and metronidazole (OAM) in 15.2% , 28.9% , and 28.6% , respectively. Regimens that contained clarithromycin were used in decreasing order in Groups Ⅰ , Ⅱ , and Ⅲ , and regimens containing metronidazole, bismuth, or tetracycline, in increasing order. The only good prognostic factor for successful eradication was Israeli origin, while European- American and Asian- African origin, recurrence of symptoms, a history of duodenal ulcer, and chronic proton pump inhibitor (PPI) use did not favor successful eradication. Our results suggest that origin, history of peptic disease, and chronic PPI use are predictors of eradication failure.
文摘Triple therapy with a proton pump inhibitor (PPI), amoxicillin, and clarithrom ycin is widely accepted for Helicobacter pylori eradication. The choice of PPI for triple therapy in Israel is arbitrary, with no preference for any one PPI exc ept for economic considerations. Direct comparison between omeprazole and lansop razole for efficacy of H. pylori eradication has never been performed in an Isra eli poplulation. Based on the pharmacokinetic data, lansoprazole-based therapy may be a better alternative than omeprazole-based therapy. The aim of this study was to compare the effectiveness of triple therapy regimens with omeprazole (L osec, AstraZeneca; or Omeradex, Dexxon) or lansoprazole (TAP Pharmaceuticals) in eradicating H. pylori infection. The database of the biggest health insurance p rovider in Israel was reviewed for all patients who received 1 week of treatment with omeprazole (n = 1293) or lansoprazole (n = 85) with additional amoxicillin and clarithromycin for H. pylori eradication in 2002. All patients underwent th e 13C-urea breath test (13CUBT) for validation of eradication. A negative 13CUB T result was noted in 1026 of the patients treated with omeprazole (79.4%) and 61 treated with lansoprazole (71.8%). On logistic regression analysis, none of the confounding factors (sex, age, indication, chronic use of PPI, eradication p rotocol) were found to contribute to the discrimination between a negative (succ essful eradication) and a positive (failed eradication) 13CUBT. There is no stat istically significant difference between omeprazole and lansoprazole as part of a PPI-based triple therapy for eradication of H. pylori.
