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Kim, Lee, Kim, Jang, and Kim: Ten-day Sequential Therapy versus Bismuth Based Quadruple Therapy as Second Line Treatment for Helicobacter pylori Infection
Original Article

Korean J Gastroenterol 2015;66(5):261-267.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.5.261

Ten-day Sequential Therapy versus Bismuth Based Quadruple Therapy as Second Line Treatment for Helicobacter pylori Infection

Sung Bum Kim, Si Hyung Lee, Kyeong Ok Kim, Byung Ik Jang, Tae Nyeun Kim

Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to: Si Hyung Lee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University Medical Center, 170 Hyeonchung- ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3985, Fax: +82-53-623-8038, E-mail: dr9696@nate.com

Received 29 July 2015       Revised 13 October 2015       Accepted 13 October 2015

Copyright © 2015 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

Ten-day sequential therapy has been evaluated as the first line therapy for Helicobacter pylori eradication but studies on sequential therapy as a second line therapy is lacking. The aim of this study was to compare the efficacy of 10-day sequential therapy and quadruple therapy as second line treatment for H. pylori eradication after failure of standard triple therapy.

Methods

Patients who did not respond to standard triple therapy for H. pylori eradication were assigned to either 10-day sequential or bismuth based quadruple therapy as second line treatment from January 2009 to December 2014 at Yeungnam University Medical Center. Post treatment H. pylori status was determined by rapid urease test, giemsa staining, or 13 C-urea breath test. Eradication rate and side effects of both therapies were compared.

Results

A total of 158 H. pylori infected patients were included and 70 patients were treated by bismuth based quadruple therapy and 88 patients by 10-day sequential therapy. Age and sex were not significantly different between the two groups. Eradication rate was 84.3% (59/70) in quadruple group and 56.8% (50/88) in sequential group. Side effects occurred significantly higher in quadruple group than sequential group (27.1% vs. 11.4%, p=0.011).

Conclusions

For second line H. pylori eradication after failure of standard triple therapy, bismuth based quadruple therapy showed significantly higher H. pylori eradication rate than 10-day sequential therapy. Further prospective studies are needed to evaluate the efficacy of 10-day sequential therapy as a second line H. pylori eradication treatment.

Keywords: Helicobacter pylori, Eradication, Anti-bacterial agents

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Fig. 1.
Comparison of eradication rate between bismuth based quadruple therapy and 10-day sequential therapy (p＜0.001).
kjg-66-261f1.tif
Fig. 2.
Flow chart. This schematic flow chart shows the number of patients included in this study. STT, standard triple therapy.
kjg-66-261f2.tif
Table 1.
Baseline Demographics and Clinical Characteristics of the Patients
Quadruple therapy (n=70) Sequential therapy (n=88) p-value
Age (yr) 59.8±13.1 59.2±11.1 0.765
Gender, male 41 (58.6) 61 (69.3) 0.161
Smoking 11 (15.7) 26 (29.5) 0.041
Endoscopic findings      
Peptic ulcer Ulcer (active or healing)/scar 32 (45.7) 23/9 23 (26.1) 18/5 0.010
Gastritis 32 (45.7) 49 (55.7) 0.213
EGC 6 (8.6) 15 (17.0) 0.119
MALT lymphoma 0 (0) 1 (1.1) 1.000
Proton pump inhibitor      
Rabeprazole 39 (55.7) 78 (88.6) ＜0.001
Esomeprazole 27 (38.6) 10 (11.4) ＜0.001
Lansoprazole 4 (5.7) 0 (0) 0.037
Treatment duration (day)      
7/10/14 51/4/15 0/88/0 ＜0.001

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

EGC, early gastric cancer; MALT, mucosa associated lymphoid tissue.

Table 2.
Adverse Events according to Second Line Eradication Regimens
  Quadruple therapy (n=70) Sequential therapy (n=88) p-value
Epigastric discomfort 1 (1.4) 5 (5.7) 0.228
Taste alteration 12 (17.1) 2 (2.3) 0.001
Loose stool 5 (7.1) 2 (2.3) 0.242
Nausea and Vomiting 1 (1.4) 2 (2.3) 1.000
Headache 1 (1.4) 0 (0) 0.443
Abdominal pain 2 (2.8) 1 (1.1) 0.585
Other 2 (2.8) 0 (0) 0.195
Total 19 (27.1) 10 (11.4) 0.011

Values are presented n (%).

Table 3.
Univariate and Multivariate Analysis for Risk Factors of Helicobacter pylori Eradication Failure
Variable Univariate analysis p-value Multivariate analysis p-value
Sequential therapy 4.076(1.888–8.800) ＜0.001 3.832(1.754–8.372) 0.001
Gender, male 0.836(0.410–1.706) 0.623    
Age 0.999(0.971–1.027) 0.929    
Rabeprazole 1.550(0.690–3.484) 0.289    
Esomeprazol 0.538(0.226–1.283) 0.162    
Lansoprazol 2.277(0.311–16.650) 0.418    
Smoking 2.364(1.103–5.067) 0.027 1.921(0.834–4.427) 0.125
EGC 3.604(1.403–9.253) 0.008 3.167(1.181–8.492) 0.022
Peptic ulcer 0.576(0.274–1.210) 0.145    
Gastritis 0.876(0.446–1.719) 0.700    
Treatment duration (＞7 days) 3.009(1.328–6.818) 0.008 0.811(0.211–3.114) 0.761

Values are presented as OR (95% CI).

EGC, early gastric cancer.

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