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Eradication of Helicobacter pylori is Expected to Improve Idiopathic Thrombocytopenic Purpura in Cases With Histologically Severe Gastritis
Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may cause rebleeding in H. pylori-eradicated patients
higher than 54.6 ± 29.7 ng/ml in non-responders (p < 0.05). PG-II was 40.5 ± 26.2 ng/ml in responders, which was significantly higher than 23.5 ± 12.2 ng/ml in non-responders (p < 0.01). [Conclusions] It was suggested that Hp eradication was more effective in cases with severer histological gastritis associated with Hp infection. The results of this study were thought to be intriguing for discussing the relationship between the pathogenesis of ITP and Hp infection.
AGA Abstracts
Tu2041 Helicobacter pylori Levofloxacin-Based Rescue Option in Patients Allergic to Penicillin Failing a Previous Treatment With Clarithromycin and Metronidazole Javier P. Gisbert, Angeles Perez Aisa, Manuel Castro-Fernandez, Jesus Barrio, Luis Rodrigo, Angel Cosme, JoseLuis Gisbert, Santiago Marcos, Ricardo Moreno-Otero
Tu2044 Comparative Study of Helicobacter pylori Eradication Rates of 5-Day Quadruple “Concomitant” Therapy and 7-Day Standard Triple Therapy Seung Young Kim, Sang Woo Lee, Bo Sung Kwon, Sung Woo Jung, Ja Seol Koo, Hyung Joon Yim, Jai Hyun Choi
BACKGROUND: Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially in those who have failed a first-eradication trial with the two key antibiotics clarithromycin and metronidazole. AIM: To assess the efficacy and safety of H. pylori levofloxacin-based rescue option in patients allergic to penicillin failing a previous treatment with a proton pump inhibitor (PPI), clarithromycin and metronidazole, extending the experience of an ongoing multicenter study. METHODS: Patients: Prospective multicenter study including consecutive patients allergic to penicillin who had failed a first eradication treatment with PPI, clarithromycin and metronidazole. Second-line treatment with PPI (standard dose b.i.d.), clarithromycin (500 mg b.i.d.) and levofloxacin (500 mg b.i.d.) was administered for 10 days. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. Incidence of adverse effects was evaluated by means of a specific questionnaire. Eradication was confirmed with 13C-urea breath test 8 weeks after completion of treatment. RESULTS: 106 patients allergic to penicillin were included (mean age 50 years, 43% males, 41% peptic ulcer, 59% functional dyspepsia). Compliance: 1 patient did not take correctly the medication (due to adverse effects: abdominal pain). Perprotocol and intention-to-treat eradication rates were 67% (95%CI=57-76%) and 66% (5775%). Adverse effects were reported in 16 patients (15%): metallic taste (8 patients), mild nausea/vomiting (7 patients), asthenia (2 patients), myalgias/arthralgias (2 patients), abdominal pain (1 patient), diarrhea (1 patient), and oral and vaginal candidiasis (1 patient). CONCLUSION: A levofloxacin-based regimen (together with a PPI and clarithromycin) represents a second-line alternative in the presence of penicillin allergy.
Background/Aims: Proton pump inhibitor (PPI)-containing triple therapy with clarithromycin and amoxicillin is a standard regimen for Helicobacter pylori (H. pylori) eradication in Korea. However, many recent studies have reported lower eradication rate than before due to increasing antibiotic resistance. Several studies showed superiority of concomitant quadruple therapy containing three antibiotics over triple therapy. The aim of this study was to compare the efficacy and safety of concomitant quadruple therapy and the standard triple therapy for the first line H. pylori eradication. Methods: A total of 270 patients with proven H. pylori infection were randomly assigned to one of two regimens: amoxicillin 1000 mg with clarithromycin 500 mg and lansoprazole 30 mg twice daily for 7 days (triple therapy group, n=135), or amoxicillin 1000 mg with clarithromycin 500 mg, metronidazole 500 mg and lansoprazole 30 mg twice daily for 5 days (concomitant therapy group, n=135). The success of H. pylori eradication was evaluated 4-5 weeks after completing treatment. Results: Eradication rates were 86.1% in the triple therapy group and 91.4% in the concomitant therapy group; there was no statically significant difference. Adverse events in both groups were generally mild, and there was no significant difference in the incidence of adverse events between two groups. Conclusion: Five-day quadruple concomitant therapy is found to eradicate H. pylori in over 90% of patients. Therefore, concomitant therapy appears to be an effective alternative to triple therapy as the first line treatment regimen for H. pylori eradication.
Tu2042
Tu2045
Fourth-Line Rescue Therapy With Rifabutin in Patients With Three H. pylori Eradication Failures Javier P. Gisbert, Manuel Castro-Fernandez, Angeles Perez Aisa, Angel Cosme, Jose Luis Cabriada, Luis Rodrigo, JoseLuis Gisbert, Eloisa Lamas, Santiago Marcos
10-Year Trend of the Cumulative Helicobacter pylori Eradication Rate of “Japanese Consecutive Eradication Strategy” Hitoshi Sasaki, Akihito Nagahara, Mariko Hojo, Masako Oguro, Hiroki Mori, Kenshi Matsumoto, Daisuke Asaoka, Taro Osada, Takashi Yoshizawa, Sumio Watanabe
BACKGROUND: In some cases, Helicobater pylori infection persists even after 3 eradication treatments. AIM: To evaluate the efficacy of an empirical forth-line rescue regimen with rifabutin in patients with 3 eradication failures, extending the experience of an ongoing multicenter study. METHODS: Design: Multicenter, prospective study. Patients: Patients in whom the following 3 eradication treatments had consecutively failed: 1st treatment: proton pump inhibitor (PPI) + clarithromycin + amoxicillin; 2nd treatment: quadruple therapy (PPI + bismuth + tetracycline + metronidazole); 3rd treatment: PPI + amoxicillin + levofloxacin. Intervention: In patients failing these 3 regimens, a 4th regimen with rifabutin (150 mg b.i.d.), amoxicillin (1 g b.i.d.) and a PPI (standard dose b.i.d.) was prescribed for 10 days. Compliance with therapy was determined from interrogatory and recovery of empty envelopes of medications. Outcome variable: H. pylori eradica¬tion was confirmed with 13C-urea breath test. RESULTS: Fifty-seven patients (mean age 51 years, 40% males, 42% peptic ulcer/58% functional dyspepsia) were included. Compliance: 4 patients did not take correctly the medication (due to adverse effects): fever, myalgia, abdominal pain and diarrhoea (1 patient) and vomiting (3 patients). Per-protocol and intention-to-treat eradication rates were 52% (95%CI=38-66%) and 49% (35-63%). Adverse effects were reported in 17 (30%) patients (none severe): nausea/vomiting (8 patients), diarrhea (2), fever (2), myalgia (2), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), abdominal pain (1), and thrombopenia (<150,000 platelets) (1). Myelotoxicity resolved spontaneously. CONCLUSION: Even after 3 previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin.
Background: Systematic eradication strategy is constructed in Japan. Patients are administered PPI/AC (PPI, amoxicillin and clarithromycin) therapy as the first line regimen and after failure of the initial treatment, PPI/AM (PPI, amoxicillin and metronidazole) therapy is prescribed as the second line regimen. Some reports described that efficacy of PPI/AC first line therapy has gradually decreased in recent years while PPI/AM second line therapy remains to give sufficient result. However, there is no study evaluating the cumulative eradication rate of this strategy. In this study, we investigated the cumulative eradication rate to verify the efficacy of “Japanese consecutive eradication strategy”. Methods: Patient with H. pylori infection received first line PPI/AC therapy and eradication failures who received following PPI/AM therapy as the second line therapy were enrolled between 2000 and 2009. The result of eradication therapy was traced in each patient's record and the annual cumulative eradication rate was calculated for 10 years. Data are shown by ITT analysis. Statistical analysis was evaluated by Cochran-Armitage Trend Test. Results: PPI/ AC first line therapy was administered to 1977 patients (male n=1081, female n=766 mean age 57.0yr range21-84 )and 251patients received PPI/AM therapy during study period. Eradication rate of PPI/AC regimen was 65.4% and it gradually decreased in 10 years with significant manner (p<0.05). PPI/AM second line regimen, the eradication rate was 85.3% and indicated no change in annual eradication rate. Regarding the cumulative eradication rate, 76.2% of patient was rescued by this “Japanese consecutive eradication strategy” and this strategy gave constant sufficient annual eradication rate without decreasing. 10-year trend is shown in the figure. Conclusion: Although decreasing the eradication rate of first line PPI/AC treatment, PPI/AC to PPI/AM “Japanese consecutive eradication strategy” provide sufficient eradication rate.
Tu2043 Eradication of Helicobacter pylori is Expected to Improve Idiopathic Thrombocytopenic Purpura in Cases With Histologically Severe Gastritis Kazuhiko Inoue, Tomoo Fujisawa, Naohito Yamashita, Keisuke Honda, Hiroaki Kusunoki, Noriaki Manabe, Tomoari Kamada, Ken Haruma It was investigated whether an improvement of ITP by Hp eradication could be predicted based on the pretreatment status of gastric mucosa. [Subjects and methods] The subjects comprised 86 cases of ITP. Infection of Hp was diagnosed by the urea breath test (UBT). Endoscopy was performed as much as possible and when platelet count was 30,000/μl or higher, biopsy samples were taken from the greater curvature of the upper gastric body and antrum, and gastritis was histologically evaluated according to the Sydney classification (none, 0; mild, 1; moderate, 2; and severe, 3). Serum pepsionogen (PG) levels were also measured. Cases with an increase in platelet count to double the pretreatment level or higher and 80,000/μl or higher after Hp eradiation were judged to be responders. [Results] Hp was infected in 60 of 86 ITP cases (69.8%) and successfully eradicated in 57 cases. Of the 57 cases, there were 32 responders (56.1%) and 25 non-responders (43.9%). As histological findings, the activity score at the antrum was 1.70 ± 0.67 in responders, which was significantly higher than 0.75 ± 0.50 in non-responders (p < 0.05). The inflammation score at the antrum was 2.50 ± 0.53 in responders, which was significantly higher than 1.50 ± 0.58 in non-responders (p < 0.05). PG-I was 89.6 ± 66.0 ng/ml in responders, which was significantly
AGA Abstracts
S-878
higher than 54.6 ± 29.7 ng/ml in non-responders (p < 0.05). PG-II was 40.5 ± 26.2 ng/ml in responders, which was significantly higher than 23.5 ± 12.2 ng/ml in non-responders (p < 0.01). [Conclusions] It was suggested that Hp eradication was more effective in cases with severer histological gastritis associated with Hp infection. The results of this study were thought to be intriguing for discussing the relationship between the pathogenesis of ITP and Hp infection.
AGA Abstracts
Tu2041 Helicobacter pylori Levofloxacin-Based Rescue Option in Patients Allergic to Penicillin Failing a Previous Treatment With Clarithromycin and Metronidazole Javier P. Gisbert, Angeles Perez Aisa, Manuel Castro-Fernandez, Jesus Barrio, Luis Rodrigo, Angel Cosme, JoseLuis Gisbert, Santiago Marcos, Ricardo Moreno-Otero
Tu2044 Comparative Study of Helicobacter pylori Eradication Rates of 5-Day Quadruple “Concomitant” Therapy and 7-Day Standard Triple Therapy Seung Young Kim, Sang Woo Lee, Bo Sung Kwon, Sung Woo Jung, Ja Seol Koo, Hyung Joon Yim, Jai Hyun Choi
BACKGROUND: Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially in those who have failed a first-eradication trial with the two key antibiotics clarithromycin and metronidazole. AIM: To assess the efficacy and safety of H. pylori levofloxacin-based rescue option in patients allergic to penicillin failing a previous treatment with a proton pump inhibitor (PPI), clarithromycin and metronidazole, extending the experience of an ongoing multicenter study. METHODS: Patients: Prospective multicenter study including consecutive patients allergic to penicillin who had failed a first eradication treatment with PPI, clarithromycin and metronidazole. Second-line treatment with PPI (standard dose b.i.d.), clarithromycin (500 mg b.i.d.) and levofloxacin (500 mg b.i.d.) was administered for 10 days. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. Incidence of adverse effects was evaluated by means of a specific questionnaire. Eradication was confirmed with 13C-urea breath test 8 weeks after completion of treatment. RESULTS: 106 patients allergic to penicillin were included (mean age 50 years, 43% males, 41% peptic ulcer, 59% functional dyspepsia). Compliance: 1 patient did not take correctly the medication (due to adverse effects: abdominal pain). Perprotocol and intention-to-treat eradication rates were 67% (95%CI=57-76%) and 66% (5775%). Adverse effects were reported in 16 patients (15%): metallic taste (8 patients), mild nausea/vomiting (7 patients), asthenia (2 patients), myalgias/arthralgias (2 patients), abdominal pain (1 patient), diarrhea (1 patient), and oral and vaginal candidiasis (1 patient). CONCLUSION: A levofloxacin-based regimen (together with a PPI and clarithromycin) represents a second-line alternative in the presence of penicillin allergy.
Background/Aims: Proton pump inhibitor (PPI)-containing triple therapy with clarithromycin and amoxicillin is a standard regimen for Helicobacter pylori (H. pylori) eradication in Korea. However, many recent studies have reported lower eradication rate than before due to increasing antibiotic resistance. Several studies showed superiority of concomitant quadruple therapy containing three antibiotics over triple therapy. The aim of this study was to compare the efficacy and safety of concomitant quadruple therapy and the standard triple therapy for the first line H. pylori eradication. Methods: A total of 270 patients with proven H. pylori infection were randomly assigned to one of two regimens: amoxicillin 1000 mg with clarithromycin 500 mg and lansoprazole 30 mg twice daily for 7 days (triple therapy group, n=135), or amoxicillin 1000 mg with clarithromycin 500 mg, metronidazole 500 mg and lansoprazole 30 mg twice daily for 5 days (concomitant therapy group, n=135). The success of H. pylori eradication was evaluated 4-5 weeks after completing treatment. Results: Eradication rates were 86.1% in the triple therapy group and 91.4% in the concomitant therapy group; there was no statically significant difference. Adverse events in both groups were generally mild, and there was no significant difference in the incidence of adverse events between two groups. Conclusion: Five-day quadruple concomitant therapy is found to eradicate H. pylori in over 90% of patients. Therefore, concomitant therapy appears to be an effective alternative to triple therapy as the first line treatment regimen for H. pylori eradication.
Tu2042
Tu2045
Fourth-Line Rescue Therapy With Rifabutin in Patients With Three H. pylori Eradication Failures Javier P. Gisbert, Manuel Castro-Fernandez, Angeles Perez Aisa, Angel Cosme, Jose Luis Cabriada, Luis Rodrigo, JoseLuis Gisbert, Eloisa Lamas, Santiago Marcos
10-Year Trend of the Cumulative Helicobacter pylori Eradication Rate of “Japanese Consecutive Eradication Strategy” Hitoshi Sasaki, Akihito Nagahara, Mariko Hojo, Masako Oguro, Hiroki Mori, Kenshi Matsumoto, Daisuke Asaoka, Taro Osada, Takashi Yoshizawa, Sumio Watanabe
BACKGROUND: In some cases, Helicobater pylori infection persists even after 3 eradication treatments. AIM: To evaluate the efficacy of an empirical forth-line rescue regimen with rifabutin in patients with 3 eradication failures, extending the experience of an ongoing multicenter study. METHODS: Design: Multicenter, prospective study. Patients: Patients in whom the following 3 eradication treatments had consecutively failed: 1st treatment: proton pump inhibitor (PPI) + clarithromycin + amoxicillin; 2nd treatment: quadruple therapy (PPI + bismuth + tetracycline + metronidazole); 3rd treatment: PPI + amoxicillin + levofloxacin. Intervention: In patients failing these 3 regimens, a 4th regimen with rifabutin (150 mg b.i.d.), amoxicillin (1 g b.i.d.) and a PPI (standard dose b.i.d.) was prescribed for 10 days. Compliance with therapy was determined from interrogatory and recovery of empty envelopes of medications. Outcome variable: H. pylori eradica¬tion was confirmed with 13C-urea breath test. RESULTS: Fifty-seven patients (mean age 51 years, 40% males, 42% peptic ulcer/58% functional dyspepsia) were included. Compliance: 4 patients did not take correctly the medication (due to adverse effects): fever, myalgia, abdominal pain and diarrhoea (1 patient) and vomiting (3 patients). Per-protocol and intention-to-treat eradication rates were 52% (95%CI=38-66%) and 49% (35-63%). Adverse effects were reported in 17 (30%) patients (none severe): nausea/vomiting (8 patients), diarrhea (2), fever (2), myalgia (2), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), abdominal pain (1), and thrombopenia (<150,000 platelets) (1). Myelotoxicity resolved spontaneously. CONCLUSION: Even after 3 previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin.
Background: Systematic eradication strategy is constructed in Japan. Patients are administered PPI/AC (PPI, amoxicillin and clarithromycin) therapy as the first line regimen and after failure of the initial treatment, PPI/AM (PPI, amoxicillin and metronidazole) therapy is prescribed as the second line regimen. Some reports described that efficacy of PPI/AC first line therapy has gradually decreased in recent years while PPI/AM second line therapy remains to give sufficient result. However, there is no study evaluating the cumulative eradication rate of this strategy. In this study, we investigated the cumulative eradication rate to verify the efficacy of “Japanese consecutive eradication strategy”. Methods: Patient with H. pylori infection received first line PPI/AC therapy and eradication failures who received following PPI/AM therapy as the second line therapy were enrolled between 2000 and 2009. The result of eradication therapy was traced in each patient's record and the annual cumulative eradication rate was calculated for 10 years. Data are shown by ITT analysis. Statistical analysis was evaluated by Cochran-Armitage Trend Test. Results: PPI/ AC first line therapy was administered to 1977 patients (male n=1081, female n=766 mean age 57.0yr range21-84 )and 251patients received PPI/AM therapy during study period. Eradication rate of PPI/AC regimen was 65.4% and it gradually decreased in 10 years with significant manner (p<0.05). PPI/AM second line regimen, the eradication rate was 85.3% and indicated no change in annual eradication rate. Regarding the cumulative eradication rate, 76.2% of patient was rescued by this “Japanese consecutive eradication strategy” and this strategy gave constant sufficient annual eradication rate without decreasing. 10-year trend is shown in the figure. Conclusion: Although decreasing the eradication rate of first line PPI/AC treatment, PPI/AC to PPI/AM “Japanese consecutive eradication strategy” provide sufficient eradication rate.
Tu2043 Eradication of Helicobacter pylori is Expected to Improve Idiopathic Thrombocytopenic Purpura in Cases With Histologically Severe Gastritis Kazuhiko Inoue, Tomoo Fujisawa, Naohito Yamashita, Keisuke Honda, Hiroaki Kusunoki, Noriaki Manabe, Tomoari Kamada, Ken Haruma It was investigated whether an improvement of ITP by Hp eradication could be predicted based on the pretreatment status of gastric mucosa. [Subjects and methods] The subjects comprised 86 cases of ITP. Infection of Hp was diagnosed by the urea breath test (UBT). Endoscopy was performed as much as possible and when platelet count was 30,000/μl or higher, biopsy samples were taken from the greater curvature of the upper gastric body and antrum, and gastritis was histologically evaluated according to the Sydney classification (none, 0; mild, 1; moderate, 2; and severe, 3). Serum pepsionogen (PG) levels were also measured. Cases with an increase in platelet count to double the pretreatment level or higher and 80,000/μl or higher after Hp eradiation were judged to be responders. [Results] Hp was infected in 60 of 86 ITP cases (69.8%) and successfully eradicated in 57 cases. Of the 57 cases, there were 32 responders (56.1%) and 25 non-responders (43.9%). As histological findings, the activity score at the antrum was 1.70 ± 0.67 in responders, which was significantly higher than 0.75 ± 0.50 in non-responders (p < 0.05). The inflammation score at the antrum was 2.50 ± 0.53 in responders, which was significantly higher than 1.50 ± 0.58 in non-responders (p < 0.05). PG-I was 89.6 ± 66.0 ng/ml in responders, which was significantly
AGA Abstracts
S-878