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Kim, Park, Kwon, Kim, Kim, and Chung: Ten Day Concomitant Therapy Is Superior to Ten Day Sequential Therapy for Helicobacter pylori Eradication
Original Article

Korean J Gastroenterol 2014;64(5):260-267.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.5.260

Ten Day Concomitant Therapy Is Superior to Ten Day Sequential Therapy for Helicobacter pylori Eradication

Su Young Kim, Dong Kyun Park, Kwang An Kwon, Kyoung Oh Kim, Yoon Jae Kim, Jun Won Chung

Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea

Correspondence to: Jun Won Chung, Department of Gastroenterology, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. Tel: +82-32-460-8930, Fax: +82-32-460-3408, E-mail: drgreen@hanmail.net

Received 7 August 201417 September 2014       Accepted 24 September 2014

Copyright © 2014 Korean Ophthalmological Society

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

Background/Aims

Because the efficacy of standard triple therapy for Helicobacter pylori eradication has declined, new regimens such as sequential therapy (ST) and concomitant therapy (CoCTx) have been introduced. The aim of this study was to compare the efficacy of 10-day ST and 10-day CoCTx for H. pylori eradication.

Methods

We retrospectively reviewed the medical records of 316 patients with proven H. pylori infection. They were assigned to one of 2 regimens; ST (n=191) consisted of, lansoprazole 30 mg and amoxicillin 1 g for 5 days followed by lansoprazole 30 mg, metronidazole 500 mg, and clarithromycin 500 mg for 5 days, and CoCTx (n=125) consisted of lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg for 10 days. All drugs were administered twice a day. Bacterial eradication was checked by using a 13 C-urea breath test at least 4 weeks after completion of treatment.

Results

The mean age and male to female ratio was 51.74 and 1.03, respectively. Baseline characteristics were not different in both groups. Ten day CoCTx group (94.4%, 118/125) showed better eradication rate than ST group (82.2%, 157/191) (p=0.002). Drug compliances were not statistically different between the two groups (p=0.19). Side effects were more frequently reported in the CoCTx group than in the ST group (p=0.03).

Conclusions

Ten-day CoCTx was superior to ST in terms of eradicating H. pylori infection. Although the CoCTx producing more side effects than ST, CoCTx can be thought to be a promising alternative to ST as a treatment regimen for H. pylori eradication.

Keywords: Helicobacter pylori, Eradication, First-line regimen

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Table 1.
Demographic Data and Endoscopic Findings of Two Patient Groups
Variable Sequential therapy (n=191) Concomitant therapy (n=125) p-value
Age (yr) 50.7±11.3 53.7±13.2 0.268
Male (male/female) 98/93 62/63 0.766
BMI (kg/m2) 23.7±3.1 23.5±3.1 0.509
Smoking 37 (19.4) 22 (17.6) 0.693
Endoscopic finding     0.002
 Peptic ulcer 114 (59.7) 49 (39.2)  
 EGC (after ESD) 8 (4.2) 13 (10.4)  
 Gastritis, gastric polyp 69 (36.1) 63 (50.4)  
Peptic ulcer stage     0.226
 Active stage 25 (21.9) 17 (34.7)  
 Healing stage 23 (20.2) 9 (18.4)  
 Scar stage 65 (57.9) 23 (46.9)  

Values are presented as mean±SD, number only, or n (%).

EGC, early gastric cancer; ESD, endoscopic submucosal dissection.

Table 2.
Comparison on Major Outcomes between Sequential Therapy and Concomitant Therapy
Variable Sequential therapy (n=191) Concomitant therapy (n=125) p-value
Eradication rate 157 (82.2) 118 (94.4) 0.002
Adverse events 57 (29.8) 53 (42.4) 0.022
Compliance 184 (96.3) 116 (92.8) 0.190

Values are presented as n (%).

Table 3.
Adverse Events during Sequential Therapy and Concomitant Therapy
Variable Sequential therapy (n=191) Concomitant therapy (n=125) p-value
Abdominal pain 13 (6.8) 8 (6.4) 0.887
Diarrhea 18 (9.4) 10 (8.0) 0.693
Nausea 18 (9.4) 12 (9.6) 0.958
Taste disturbance 19 (9.9) 24 (19.2) 0.019
Headache 8 (4.2) 2 (1.6) 0.199
Skin rash 6 (3.1) 0 (0.0) 0.045
General weakness 13 (6.8) 2 (1.6) 0.033
Overall 57 (29.8) 53 (42.4) 0.022

Values are presented as n (%).

Table 4.
Risk Factors Associated with Helicobacter pylori Eradication Failure
Variable Data, n (%) Univariate
 Multivariate
OR (95% CI) p-value OR (95% CI) p-value
Gender          
 Male 160 (50.6) 1 (reference)   1 (reference)  
 Female 156 (49.4) 1.93 (0.98-3.80) 0.054 1.30 (0.62-2.71) 0.492
Age (yr)          
 <60 234 (74.1) 1 (reference)      
 ≥60 82 (25.9) 1.39 (0.68-2.86) 0.367    
BMI (kg/m2)          
 <25 219 (69.3) 1 (reference)      
 ≥25 97 (30.7) 0.70 (0.33-1.49) 0.348    
Smoking          
 Yes 59 (18.7) 1 (reference)   1 (reference)  
 No 257 (81.3) 5.10 (1.20-21.80) 0.015 5.30 (1.20-23.44) 0.028
Endoscopic findings          
 PU 163 (51.6) 1 (reference)      
 Others a 153 (48.4) 1.02 (0.53-2.00) 0.960    
Peptic ulcer stage          
 S 89 (54.6) 1 (reference)      
 A+H 74 (45.4) 1.11 (0.44-2.78) 0.827    
Eradication regimen          
 Concomitant 125 (39.6) 1 (reference)   1 (reference)  
 Sequential 191 (60.4) 3.65 (1.56-8.52) 0.002 5.06 (1.98-12.91) 0.001
Compliance          
 Good 300 (94.9) 1 (reference)   1 (reference)  
 Poor 16 (5.1) 6.09 (2.13-17.39) <0.001 8.99 (2.73-29.53) <0.001

PU, peptic ulcer; S, scar stage; A, active stage; H, healing stage.

a Early gastric cancer (after endoscopic submucosal dissection)+ gastritis+ gastric polyp.

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