Changes in the Eradication Rate of Conventional Triple Therapy for Helicobacter pylori Infection in Korea

Jun Heo; Seong Woo Jeon

doi:10.4166/kjg.2014.63.3.141

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Heo and Jeon: Changes in the Eradication Rate of Conventional Triple Therapy for Helicobacter pylori Infection in Korea

Review Article

Korean J Gastroenterol 2014;63(3):141-145.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.3.141

Changes in the Eradication Rate of Conventional Triple Therapy for Helicobacter pylori Infection in Korea

Jun Heo, Seong Woo Jeon

Deparment of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to: Seong Woo Jeon, Department of Internal Medicine, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu 702-911, Korea. Tel: +82-53-200-2602, Fax: +82-53-200-2027, E-mail: sw-jeon@hanmail.net

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although, the prevalence of Helicobacter pylori infection in Korea has declined owing to the eradication therapy, recent seroprevalence of H. pylori infection is still reported to be as high as 54.4%. Until now, “standard regimen” for eradication of H. pylori has been conventional triple therapy consisting of proton pump inhibitor, amoxicillin, and clarithromycin. However, with the increase in antibiotic resistance, especially against clarithromycin, the eradication rate of conventional triple therapy has steadily declined during the past 13 years in Korea. Present eradication rate of standard triple therapy is reported to be less than 80%, which is the Maginot line of efficacy for the currently available regimen. Therefore, new first line eradication regimen is needed to enhance the eradication rate of H. pylori infection.

Keywords: Helicobacter pylori, Eradication, Anti-bacterial agents

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Fig. 1.

The decreasing trend of Helicobacter pylori eradication rate with conventional triple therapy in Korea.

Table 1.

Recent Studies Evaluating Conventional Triple Therapy for Eradication of Helicobacter pylori Infection in Korea

First author	Year of publication	Study duration	Study design	Treatment^a	Duration of treatment (day)	Patient (n)	Eradication rate (ITT, %)	Eradication rate (PP, %)
Jang²⁵	2005	2003–2004	RCT	PPI＋ A 1,000 mg＋ C 500 mg	7	75	78.7	85.5
Choi¹⁹	2006	1998–2005	Retro	PPI＋ A 1,000 mg＋ C 500 mg	7	525		78.7
Kim¹⁵	2007	2002–2003	RCT	O 20 mg＋ A 1,000 mg＋ C 500 mg	7	337	71.2	83.6
Na²²	2007	2001–2006	Retro	PPI＋ A 1,000 mg＋ C 500 mg	7	3,267		84.5
Kim²⁴	2008	2005–2006	RCT	O 20 mg＋ A 1,000 mg＋ C 500 mg	14	93	91.4	92.1
Choi²⁶	2008	2007	RCT	O 20 mg＋ A 1,000 mg＋ C 500 mg	7	81	71.6	76.6
Song³²	2009	1997–2007	Retro	PPI＋ A 1,000 mg＋ C 500 mg	7 or 14	1,789		85.5
Cho³³	2009	1999–2007	Retro	PPI＋ A 1,000 mg＋ C 500 mg	−	615		81.6
Chung²¹	2009	2003–2007	Retro	PPI＋ A 1,000 mg＋ C 500 mg	7	1,716		82.5
Cho¹⁸	2010	2001–2009	Retro	PPI＋ A 1,000 mg＋ C 500 mg	7	709		77
Kim²⁸	2011	2008–2009	RCT	P 40 mg＋ A 1,000 mg＋ C 500 mg	14	204	75	85
Kim³⁶	2011	2006–2010	Retro	PPI＋ A 1,000 mg＋ C 500 mg	7	120		89.2
Choi²⁹	2012	2008–2011	RCT	R 20 mg＋ A 1,000 mg＋ C 500 mg	7	115	70.4	75.7
				R 20 mg＋ A 1,000 mg＋ C 500 mg	10	115	74.7	81.9
				R 20 mg＋ A 1,000 mg＋ C 500 mg	14	115	80	84.4
Chung³⁰	2012	2010–2011	RCT	L 30 mg＋ A 1,000 mg＋ C 500 mg	10	80	58.7	67.6
Kim³⁵	2012	2009–2010	RCT	L 30 mg＋ A 1,000 mg＋ C 500 mg	14	104	74	82.8
Oh³¹	2012	2009–2010	RCT	R 20 mg＋ A 1,000 mg＋ C 500 mg	7	130	63	64.5
Park²⁷	2012	2009–2010	RCT	R 20 mg＋ A 1,000 mg＋ C 500 mg	7	164	62.2	76
An^23,b	2013	2009–2012	Retro	P or E 30 mg＋ A 2,250 mg＋ C 1,000 mg	g 7	66		75.8
Kim³⁴	2013	2009–2010	RCT	L 30 mg＋ A 1,000 mg＋ C 500 mg	7	135	72.6	85.2

^a All the medications were prescribed twice a day, except

^b An et al. (amoxiciliin, three times a day).

ITT, intention-to-treat; PP, per-protocol; RCT, randomized-controlled trial; Retro, retrospective cohort study; PPI, proton pump inhibitor; A, amoxicillin; C, clarithromycin; O, omeprazole; R, rabeprazole; P, pantoprazole; L, lansoprazole; E, esomeprazole.

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