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Cho, Park, Kee, Lee, Ki, Yoon, Cho, Lee, Joo, Kim, Choi, and Rew: The Trend of Eradication Rate of Helicobacter pylori Infection and Clinical Factors That Affect the Eradication of First-line Therapy
Original Article

Korean J Gastroenterol 2010;55(6):368-375.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.6.368

The Trend of Eradication Rate of Helicobacter pylori Infection and Clinical Factors That Affect the Eradication of First-line Therapy

Dong Keun Cho, M.D., Seon Young Park, M.D., Won Ju Kee, M.D., Jeong Hyeon Lee, M.D., Ho Seok Ki, M.D., Kyung-Won Yoon, M.D., Sung Bum Cho, M.D., Wan Sik Lee, M.D., Young Eun Joo, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D.

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea

Correspondence to: Jong Sun Rew, M.D. Department of Internal Medicine, Chonnam National University Medical School, 8, Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: +82-62-220-6296, Fax: +82-62-228-1330 E-mail: jsrew@chonnam.ac.kr

Received 6 January 2010       Accepted 23 February 2010

Copyright © 2010 The Korean Journal of Gastroenterology

Abstract

Background/Aims

Although triple combination therapy containing a proton pump inhibitor (PPI) and two antibiotics is considered as a standard regimen for the first-line anti-Helicobacter pylori treatment, the recent trend of eradication rates following this therapy has been declined in the last few years. The purpose of this study was to investigate the trend of H. pylori eradication rates over the last 9 years and to evaluate are clinical factors affecting eradication rates.

Methods

From January 2001 to June 2009, H. pylori eradication rates in 709 patients with documented H. pylori infection who received triple combination therapy for 7 days were retrospectively evaluated according to years and various clinical factors. H. pylori status was evaluated by 13 C urea breath test 4-6 weeks after completion of treatment.

Results

The overall H. pylori eradication rate was 77.0%. The annual eradication rates from year 2001 to 2009 were 78.9%, 72.5%, 81.0%, 75.0%, 79.1%, 77.1%, 77.8%, 77.8%, and 75.0% by per-protocol analysis. There was no decreasing tendency of the eradiation rate over 9 years (p=0.974). There was no statistical difference in the eradication rates according to age, sex, smoking, alcohol, NSAIDs, underlying diseases, endoscopic diagnosis, and PPI. However, the eradication rate was lower in patients who took aspirin (OR=0.509, 95% CI=0.292-0.887, p=0.001) and antibiotics within 6 months (OR=0.347, 95% CI=0.183-0.658, p=0.001).

Conclusions

The H. pylori eradication rate has not changed at Gwangju-Chonnam province in Korea for recent 9 years. Lower eradication rate in aspirin and antibiotics users warrants further attention.

Keywords: Helicobacter pylori, First-line triple therapy, Eradication rate

REFERENCES

1. Malfertheiner P, Leodolter A, Peitz U. Cure of Helicobacter pylori-associated ulcer disease through eradication. Baillieres Best Pract Res Clin Gastroenterol. 2000; 14:119–132.
2. Hunt RH. Eradication of Helicobacter pylori infection. Am J Med. 1996; 100(5A):S42–S50.
3. Huang JQ, Hunt RH. Treatment after failure: the problem of “non-responders”. Gut. 1999; 45:140–144.
crossref
4. Laheij RJ, Rossum LG, Jansen JB, Straatman H, Verbeek AL. Evaluation of treatment regimens to cure Helicobacter pylori infection–a metaanalysis. Aliment Pharmacol Ther. 1999; 13:857–864.
5. Perri F, Qasim A, Marras L, O'Morain C. Treatment of Helicobacter pylori infection. Helicobacter. 2003; 8(suppl 1):S53–S60.
6. Choi YS, Cheon JH, Lee JY, et al. The trend of eradication rates of first-line triple therapy for Helicobacter pylori infection: single center experience for recent eight years. Korean J Gastroenterol. 2006; 48:156–161.
7. Na HS, Hong SJ, Yoon HJ, et al. Eradication rate of first-line and second-line therapy for Helicobacter pylori infection, and reinfection rate after successful eradication. Korean J Gastroenterol. 2007; 50:170–175.
8. Cho HJ, Bae RC, Lee SH, et al. The trend in the eradication rates of first- and second-line therapy for Helicobacter pylori infection in Daegu and Kyungpook provinces: a single center experience for the most recent 9 years. Korean J Med. 2009; 76:186–192.
9. Song JG, Lee SW, Park JY, et al. Trend in the eradication rates of Helicobacter pylori infection in the last 11 years. Korean J Med. 2009; 76:303–310.
10. Nam TM, Lee DH, Kang KP, et al. Clinical factors that potentially affect the treatment outcome of Helicobacter pylori eradication therapy with using a standard triple regimen in peptic ulcer patients. Korean J Gastrointest Endosc. 2008; 36:200–205.
11. Byun YH, Jo YJ, Kim SC, et al. Clinical factors that predicts successful eradication of Helicobacter pylori. Korean J Gastroenterol. 2006; 48:172–179.
12. Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007; 56:772–781.
13. Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol. 1998; 13:1–12.
14. Mé graud F. H pylori antibiotic resistance: prevalence, im-portance, and advances in testing. Gut. 2004; 53:1374–1384.
15. Treiber G, Ammon S, Klotz U. Age-dependent eradication of Helicobacter pylori with dual therapy. Aliment Pharmacol Ther. 1997; 11:711–718.
16. Baena JM, Ló pez C, Hidalgo A, et al. Relation between alcohol consumption and the success of Helicobacter pylori eradication therapy using omeprazole, clarithromycin and amoxicillin for 1 week. Eur J Gastroenterol Hepatol. 2002; 14:291–296.
17. Kim JJ, Reddy R, Lee M, et al. Analysis of metronidazole, clarithromycin and tetracycline resistance of Helicobacter pylori isolates from Korea. J Antimicrob Chemother. 2001; 47:459–461.
18. Kim JM, Kim JS, Jung HC, Kim N, Song IS. Antibiotic resistance of Helicobacter pylori isolated from korean patients in 2003. Korean J Gastroenterol. 2004; 44:126–135.
19. Suzuki T, Matsuo K, Ito H, et al. Smoking increases the treatment failure for Helicobacter pylori eradication. Am J Med. 2006; 119:217–224.
20. Kuepper-Nybelen J, Thefeld W, Rothenbacher D, Brenner H. Patterns of alcohol consumption and Helicobacter pylori infection: results of a population-based study from Germany among 6545 adults. Aliment Pharmacol Ther. 2005; 21:57–64.
21. Sargý n M, Uygur-Bayramicli O, Sargý n H, Orbay E, Yavuzer D, Yayla A. Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori. World J Gastroenterol. 2003; 9:1126–1128.
22. Osawa H, Kawakami M, Fujii M, et al. Helicobacter pylori infection and coronary heart disease in Japanese patients. Cardiology. 2001; 95:14–19.
23. Aydemir S, Boyacioglu S, Gur G, et al. Helicobacter pylori infection in hemodialysis patients: susceptibility to amoxicillin and clarithromycin. World J Gastroenterol. 2005; 11:842–845.
24. Tsukada K, Miyazaki T, Katoh H, et al. Seven-day triple therapy with omeprazole, amoxycillin and clarithromycin for Helicobacter pylori infection in haemodialysis patients. Scand J Gastroenterol. 2002; 37:1265–1268.
25. Jung SW, Lee SW, Hyun JJ, et al. Efficacy of Helicobacter pylori eradication therapy in chronic liver disease. Dig Liver Dis. 2009; 41:134–140.
26. Gencer M, Ceylan E, Yildiz Zeyrek F, Aksoy N. Helicobacter pylori seroprevalence in patients with chronic obstructive pulmonary disease and its relation to pulmonary function tests. Respiration. 2007; 74:170–175.
27. Erah PO, Goddard AF, Barrett DA, Shaw PN, Spiller RC. The stability of amoxycillin, clarithromycin and metronidazole in gastric juice: relevance to the treatment of Helicobacter pylori infection. J Antimicrob Chemother. 1997; 39:5–12.
28. Peterson WL. The role of antisecretory drugs in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther. 1997; 11(suppl 1):S21–S25.
29. Vergara M, Vallve M, Gisbert JP, Calvet X. Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2003; 18:647–654.
30. Keum B, Lee SW, Kim SY, et al. Comparison of Helicobacter pylori eradication rate according to different PPI-based triple therapy: omeprazole, rabeprazole, esomeprazole and lansoprazole. Korean J Gastroenterol. 2005; 46:433–439.
31. Inaba T, Mizuno M, Kawai K, et al. Randomized open trial for comparison of proton pump inhibitors in triple therapy for Helicobacter pylori infection in relation to CYP2C19 genotype. J Gastroenterol Hepatol. 2002; 17:748–753.
32. Miwa H, Yamada T, Sato K, et al. Efficacy of reduced dos-age of rabeprazole in PPI/AC therapy for Helicobacter pylori infection: comparison of 20 and 40 mg rabeprazole with 60 mg lansoprazole. Dig Dis Sci. 2000; 45:77–82.
33. Kawai T, Kawakami K, Mikinori K, et al. Efficacy of low-dose proton pump inhibitor (PPI) in the eradication of Helicobacter pylori following combination PPI/AC therapy in Japan. Hepatogastroenterology. 2007; 54:649–654.
34. Zhang XP, Wang WH, Tian Y, Gao W, Li J. Aspirin increases susceptibility of Helicobacter pylori to metronidazole by augmenting endocellular concentrations of antimicrobials. World J Gastroenterol. 2009; 15:919–926.
35. Wang WH, Wong WM, Dailidiene D, et al. Aspirin inhibits the growth of Helicobacter pylori and enhances its susceptibility to antimicrobial agents. Gut. 2003; 52:490–495.
36. Caselli M, Pazzi P, LaCorte R, Aleotti A, Trevisani L, Stabellini G. Campylobacter-like organisms, nonsteroidal anti-inflammatory drugs and gastric lesions in patients with rheumatoid arthritis. Digestion. 1989; 44:101–104.
crossref
37. Park SH, Park DI, Kim SH, et al. Effect of high-dose aspirin on Helicobacter pylori eradication. Dig Dis Sci. 2005; 50:626–629.
38. Kauffman G. Aspirin-induced gastric mucosal injury: lessons learned from animal models. Gastroenterology. 1989; 96(suppl 2):S606–S614.
crossref

Table 1.
Baseline Characteristics of Patients
Variables
Age (yr) (mean± SD) 54.9±13.9
Sex (M:F) 1.74:1
Smoking 28.9% (205/709)
Alcohol intake 37.5% (266/709)
Aspirin use 9.9% (70/709)
NSAIDs use 3.4% (24/709)
Antibiotics use 6.1% (43/709)
Underlying diseases
   Diabetes mellitus 10.0% (71/709)
   Hypertension 17.3% (123/709)
   Chronic kidney disease 0.7% (5/709)
   Chronic liver disease 7.3% (52/709)
   Chronic lung disease 2.1% (15/709)
   Coronary artery disease 3.7% (26/709)
Endoscopic diagnosis
   Gastric ulcer 44.4% (315/709)
   Duodenal ulcer 22.7% (161/709)
   Gastric ulcer+Duodenal ulcer 8.0% (57/709)
   Others∗ 24.8% (176/709)

NSAIDs, non-steroidal anti-inflammatory drugs.

∗ Others include gastritis, gastric polyp, gastric adenoma, early gastric cancer and MALT lymphoma.

Table 2.
Helicobacter pylori Eradication Rates according to Clinical Factors
Eradication rate cOR 95% CI p-value
Total eradication rate 77.0% (546/709)
Clinical factors
Sex
   Male 76.9% (347/451) 1 0.953
   Female 77.1% (199/258) 1.011 0.703-1.455
Smoking
   Non-smoker 76.4% (385/504) 1 0.538
   Smoker 78.5% (161/205) 1.131 0.764-1.673
Alcohol
   Non-drinker 77.2% (342/443) 1 0.876
   Drinker 76.7% (204/266) 0.972 0.678-1.394
Aspirin
   Non-user 78.7% (503/639) 1 0.001
   User 61.4% (43/70) 0.431 0.257-0.722
NSAIDs
   Non-User 77.2% (529/685) 1 0.466
   User 70.8% (17/24) 0.716 0.292-1.758
Antibiotics
   Non-User 78.5% (523/666) 1 0.001
   User 53.5% (23/43) 0.314 0.168-0.589
Underlying diseases
   Diabetes mellitus 64.8% (46/71) 0.508 0.301-0.856 0.011
   Hypertension 72.4% (89/123) 0.739 0.475-1.148 0.179
   Chronic kidney disease 80.0% (4/5) 1.196 0.133-10.772 0.873
   Chronic liver disease 73.1% (38/52) 0.796 0.420-1.509 0.488
   Chronic lung disease 80.0% (12/15) 1.199 0.334-4.299 0.781
   Coronary artery disease 65.4% (17/26) 0.550 0.240-1.258 0.157
Presence of underlying disease
   Absence 78.9% (381/483) 1 0.084
   Presence 73.0% (165/226) 0.724 0.052-1.044

cOR, crude odd ratio; CI, confidence interval; NSAIDs, non-steroidal anti-inflammatory drugs.

Table 3.
Multiple Logistic Regression on Clinical Factors Associated Helicobacter pylori Eradication
aOR 95% CI p-value
Aspirin 0.509 0.292-0.887 0.017
Antibiotics 0.347 0.183-0.658 0.001
Diabetes mellitus 0.687 0.389-1.214 0.196

aOR, adjusted odd ratio; CI, confidence interval.

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