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M1123 Prevalence and Molecular Mechanism of Fluoroquinolone Resistance of Helicobacter pylori Strains in Korea
M1125 Comparison of Triple Rabeprazole/Metronidazole/Sitafloxacin Therapy With Triple Rabeprazole/Amoxicillin/Sitafloxacin Therapy as the Third Rescue Regimen for Eradication of H. pylori Takahisa Furuta, Mitsushige Sugimoto, Chise Kodaira, Masafumi Nishino, Mihoko Yamade, Takahiro Uotani, Mutsuhiro Ikuma
M1122 Results of Multicenter Open Prospective Randomized Trial of Helicobacter pylori Eradication: Nitrofuran-Based Triple Therapy Versus MetronidazoleBased Triple Therapy Peter Shcherbakov, Erdes Svetlana, Marina Shcherbakova, Alfia Aminova, Elena Kornienko, Reseda Faizulina, Dmitryi Pasechnikov, Anna Logvinova
Background/Aims: Fluoroquinolone-based therapy has been used as the third rescue regimen after failure to eradicate Helicobacter pylori via triple therapy with a proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) or with a PPI, metronidazole (MNZ), and AMPC. Sitafloxacin (STFX), one of the fluoroquinolone, has a lower minimum inhibitory concentration for H. pylori than do other quinolones such as levofloxacin. However, the optimum antimicrobial agent for use with STFX has not been determined. Here, we assessed whether the antimicrobial agent AMPC or MNZ functioned better with STFX as the third rescue regimen for eradication of H. pylori. Methods: The present study enrolled 24 patients in whom H. pylori eradication failed despite two or more treatment regimens (first: PPI/ AMPC/CAM; second: PPI/AMPC/MNZ). Patients were treated either twice daily with rabeprazole (RPZ) 10 mg, twice daily with STFX 100 mg, and four times daily with AMPC 500 mg, or twice daily with RPZ 10 mg, twice daily with STFX 100 mg bid, and twice daily with MNZ 250 mg for 1 week. At four weeks after treatment, patients undewent [13C]urea breath test. If results were negative, patients then underwent endoscopy to confirm successful eradication by rapid urease test. Results: All patients completed the treatment, and eradication rates for the RPZ/AMPC/STFX and RPZ/MNZ/STFX regimens were 91.6% and 100.0%, respectively (respective 95% confidence intervals: 61.5%-99.8% and 77.9%100.0%). No undesirable adverse events were observed during the study period. Conclusion: STFX administered twice daily at 100 mg achieved sufficient rescue eradication rates with both MNZ (250 mg twice daily) and AMPC (500 mg four times daily) when used with RPZ administered twice daily at 10 mg. Such an STFX-based triple therapy with RPZ and either AMPC or MNZ may be effective as a rescue regimen for H. pylori infection in patients refractory to the standard therapy with a PPI, AMPC, and CAM or MNZ.
Introduction: Nowadays the main reason for antibacterial therapy inefficiency is considered to be the increase of H. pylori resistance to antibacterial drugs of standard triple therapy. Aims & Methods: Aim of the study was to compare the efficacy and tolerability of 2 dosage different first-line nifuroxazid-, metronidazole-based schemes for eradication of H. pylori infection in pediatrics. We enrolled 161 children ( 7-17 years aged: 77 girls & 84 boys) with stomach and duodenum H pylori infections. Pationts underwent 13C urea breath test, upper endoscopy, histology, rapid urease test. Upper endoscopy was assessed before treatment and 8 weeks after the end of therapy. Patients were randomized into group A: lancoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), enterofuril suspension 400mg/day (ages 7 years to 12 years) and 800mg/day ( ages 12 years to 17 years)& group B: lansoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), metronidazole 500mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), each administered twice a day. Results: All 161 patients finished anti-Hp therapy in both groups. Eradications rates were: group A - 70%,p=0,036 (enterofuril 400 mg/day - 66%, p=0,067, 800mg/day - 87,5%, p=0,047), group B 46%,p=0,064. Mild side effects (nausea, diarrhea, allergic eruption) were reported in 12 patients. More side effects were in group B than A (group A: 4pts, group B: 3pts). No severe adverse events were observed. Epithalization of stomach ulcer and erosion was reported in 8 among 9 patients in group B. Conclusion: Nitrofuran-based triple therapy is more effective than metronidazole-based triple therapy for the eradication of H. pylori in children.
M1126 Effectiveness of a 10-Day Triple Therapy Combining Potent Acid Inhibition With Amoxicillin and Metronidazole for H. pylori Eradication in Clinical Practice. A Pilot Study Jordi Sánchez-Delgado, Pilar García-Iglesias, Xavier Calvet, Manuel Castro-Fernandez, Felipe Bory, Mercè Barenys, Luis Bujanda, Jacobo M. Lizasoain, María M. Calvo, Sandra Torra
M1123 Prevalence and Molecular Mechanism of Fluoroquinolone Resistance of Helicobacter pylori Strains in Korea Jun-Won Chung, Gin Hyug Lee, Jin-Yong Jeong, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Hwoon-Yong Jung, Jin-Ho Kim
Introduction: Eradication rates of Helicobacter pylori infection with standard triple therapy are disappointingly low, mostly because of the increased rates of clarithromycin resistance. New strategies of treatment are, thus, necessary. Previous studies have shown that potent acid inhibition using esomeprazole increases cure rates with triple therapy and that 10-day treatments are more effective than 7-day ones. In addition, the combination of amoxicillin plus metronidazole at full doses three times a day has been shown to overcome metronidazole resistance, to achieve good eradication rates and its efficacy is not impaired by clarithromycin resistance. Objective: 1) To assess the eradication rate of a new treatment regimen associating potent acid inhibition, amoxicillin and metronidazole. 2) To evaluate the tolerance to this therapeutic regime. Material and methods: 136 patients from 8 different centres were included in a pilot observational study performed under clinical practice conditions. H. pylori status was assessed before treatment by at least one of the following: histology, culture, rapid urease test or urea breath test. Ten-day treatment, including esomeprazol 40 mg b.d., amoxicillin 1 g t.i.d and metronidazol 500 mg t.i.d, with meals was prescribed. H. pylori cure was assessed by urea breath test. Eradication rates and their 95% confidence intervals were calculated both by intention-to-treat and per protocol. Results: A total of 136 patients were enrolled. Mean age was 52.6 ±16 years and 59.6% were men. Indications for treatment were non-investigated dyspepsia (13.6%); functional dyspepsia (18.8%); gastric ulcer (21.8 %) and duodenal ulcer (39.8 %). H. pylori infection was diagnosed by histology, rapid urease test or urea breath test. H. pylori eradication was achieved in 112 out of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intentionto-treat analysis and 88.2% (95% CI: 81.2-92.8) per protocol. The treatment was well tolerated and no major side effects were reported. Only 9 patients complained of mild side effects (the most frequent being metallic taste and diarrhoea). Conclusions: The evaluated combination of esomeprazole, amoxicillin and metronidazole is well tolerated and seems highly effective to eradicate H. pylori. This pilot study warrants the comparison of this new schedule with current standards.
Background: New regimens including newer fluoroquinolones have been developed, due to the increasing resistance of Helicobacter pylori. We aimed to assess the fluoroquinolone resistance rate as well as the mechanisms of resistance in clinical isolates in Korea. Methods: Minimal inhibitory concentration (MIC) values of ciprofloxacin were determined by agar dilution method on 192 H. pylori isolates. Resistant strains (MIC values > 1 μg/ml) were evaluated for the presence of point mutations in the quinolone resistance determining region (QRDR) of the gyrA and gyrB by amplification and nucleotide sequence. Results: Thirtytwo (32/192, 16.6%) of the strains were found resistant to fluoroquinolones. The most common mutations in H. pylori gyrA gene were found at codons corresponding to Asp87 (50.0%), Asn91 (34.3%), Ala88 (6.2%). Two novel gyrA mutations were noted Asp91Asn/ Asp143Glu and Arg130Lys were also detected. Double mutations (Asp481Glu and Arg484Lys) in gyrB were detected in three strains (9.3%). Conclusions: These results suggest that H. pylori resistance to fluoroquinolones is common in the Korea population. The resistance is most likely mediated through amino acid point mutation in gyrA. However, novel mutation is emerging, therefore, further surveillance is required. M1124 Randomized Comparison of One or Two Week Bismuth Based Quadruple Therapy for Salvage Helicobacter pylori Eradication Jun-Won Chung, Hwoon-Yong Jung, Tae-Hoon Oh, Do Hoon Kim, Kwi-Sook Choi, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim Aim: Direct comparisons of one and two week bismuth-based quadruple therapies for salvage Helicobacter pylori eradication are lacking. A randomized study was conducted to compare efficacy, compliance, and adverse effect of two regimens. Methods: One hundred and eighty patients who failed H. pylori eradication were randomized to receive pantoprazole 40mg twice daily, metronidazole 500 mg thrice daily, bismuth subcitrate 300 mg and tetracycline 500 mg four times daily for 7 days (PBMT7) or 14 days (PBMT14). Post-treatment H. pylori status was determined by 13C-urea breath test. Results:The eradication rates were 80.4% (74/92) and 88.6 % (70/79) with PBMT7, and 84.1% (74/88) and 97.1% (68/70) by intentionto-treat (p=0.39) and per-protocol analyses (p=0.10). PBMT14 had more common adverse events than PBMT7 [51.1% (45/88) vs. 32.6% (30/92), p=0.02] Although numerically high drop-out rate was observed in PBMT14 [10.2% (9/88)] than PBMT7 [4.3% (4/92)], there was no statistical difference between two groups (p=0.11). Conclusion: PBMT7 was as effective as PBMT14 with less moderate-severe adverse effect. Therefore, it may be sufficient to use one week quadruple therapy for the salvage H. pylori treatment in Korea.
M1127 Analysis of Related Factors of H. pylori Eradication Therapy Efficiency Liya Zhou, Huang Feng, Yan Xue, XueLing Yang, Sanren Lin Objective:To investigate the related factors of H. pylori eradication therapy efficiency. Materials and methods: A total number of 1603 patients diagnosed as H. pylori infection by WS stain were enrolled and received H. pylori eradication therapy. The 13 C-urea breath test was taken more than 4 weeks after the therapy to assess the efficiency. The general datas, underlying upper gastrointestinal disease, initial treated or retreated ,the therapeutic regimes, and the duration were compared and analyzed statistically. Results: 1.For all patients, H. pylori was eradication rate: 77.9%. 2. The eradication rate of the peptic ulcer group was 88.8%, higher than that of the non-ulcer group (74.8%, P=0.000). 3.The eradication rate of the initial treated group was 78.6%, higher than that of the retreated group (65.2%,P= 0.003). 4.The eradication rate of quadruple therapy was higher than triple therapy, 84.3% and 74% respectively(P=0.000), the eradication rate of sequential therapy was 77.5%.The differenc between triple therapy and sequential therapy, sequential and triple therapy were not significant different.(P=0.497,0.696) 5.In the initial treated group ,the eradication rate of the 14-day was higher than 7-day and 10-day treatment, with the eradication rate 90.2%,75.4% and 81.8% respetively(P=0.004,0.006).There was not significant differenc
S-337
AGA Abstracts
AGA Abstracts
and amoxicillin are found to be equally effective and more safe compared with triple therapy. Therefore, dual therapy will be one of option as the first line treatment regimen of H. pylori eradication.
M1122 Results of Multicenter Open Prospective Randomized Trial of Helicobacter pylori Eradication: Nitrofuran-Based Triple Therapy Versus MetronidazoleBased Triple Therapy Peter Shcherbakov, Erdes Svetlana, Marina Shcherbakova, Alfia Aminova, Elena Kornienko, Reseda Faizulina, Dmitryi Pasechnikov, Anna Logvinova
Background/Aims: Fluoroquinolone-based therapy has been used as the third rescue regimen after failure to eradicate Helicobacter pylori via triple therapy with a proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) or with a PPI, metronidazole (MNZ), and AMPC. Sitafloxacin (STFX), one of the fluoroquinolone, has a lower minimum inhibitory concentration for H. pylori than do other quinolones such as levofloxacin. However, the optimum antimicrobial agent for use with STFX has not been determined. Here, we assessed whether the antimicrobial agent AMPC or MNZ functioned better with STFX as the third rescue regimen for eradication of H. pylori. Methods: The present study enrolled 24 patients in whom H. pylori eradication failed despite two or more treatment regimens (first: PPI/ AMPC/CAM; second: PPI/AMPC/MNZ). Patients were treated either twice daily with rabeprazole (RPZ) 10 mg, twice daily with STFX 100 mg, and four times daily with AMPC 500 mg, or twice daily with RPZ 10 mg, twice daily with STFX 100 mg bid, and twice daily with MNZ 250 mg for 1 week. At four weeks after treatment, patients undewent [13C]urea breath test. If results were negative, patients then underwent endoscopy to confirm successful eradication by rapid urease test. Results: All patients completed the treatment, and eradication rates for the RPZ/AMPC/STFX and RPZ/MNZ/STFX regimens were 91.6% and 100.0%, respectively (respective 95% confidence intervals: 61.5%-99.8% and 77.9%100.0%). No undesirable adverse events were observed during the study period. Conclusion: STFX administered twice daily at 100 mg achieved sufficient rescue eradication rates with both MNZ (250 mg twice daily) and AMPC (500 mg four times daily) when used with RPZ administered twice daily at 10 mg. Such an STFX-based triple therapy with RPZ and either AMPC or MNZ may be effective as a rescue regimen for H. pylori infection in patients refractory to the standard therapy with a PPI, AMPC, and CAM or MNZ.
Introduction: Nowadays the main reason for antibacterial therapy inefficiency is considered to be the increase of H. pylori resistance to antibacterial drugs of standard triple therapy. Aims & Methods: Aim of the study was to compare the efficacy and tolerability of 2 dosage different first-line nifuroxazid-, metronidazole-based schemes for eradication of H. pylori infection in pediatrics. We enrolled 161 children ( 7-17 years aged: 77 girls & 84 boys) with stomach and duodenum H pylori infections. Pationts underwent 13C urea breath test, upper endoscopy, histology, rapid urease test. Upper endoscopy was assessed before treatment and 8 weeks after the end of therapy. Patients were randomized into group A: lancoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), enterofuril suspension 400mg/day (ages 7 years to 12 years) and 800mg/day ( ages 12 years to 17 years)& group B: lansoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), metronidazole 500mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), each administered twice a day. Results: All 161 patients finished anti-Hp therapy in both groups. Eradications rates were: group A - 70%,p=0,036 (enterofuril 400 mg/day - 66%, p=0,067, 800mg/day - 87,5%, p=0,047), group B 46%,p=0,064. Mild side effects (nausea, diarrhea, allergic eruption) were reported in 12 patients. More side effects were in group B than A (group A: 4pts, group B: 3pts). No severe adverse events were observed. Epithalization of stomach ulcer and erosion was reported in 8 among 9 patients in group B. Conclusion: Nitrofuran-based triple therapy is more effective than metronidazole-based triple therapy for the eradication of H. pylori in children.
M1126 Effectiveness of a 10-Day Triple Therapy Combining Potent Acid Inhibition With Amoxicillin and Metronidazole for H. pylori Eradication in Clinical Practice. A Pilot Study Jordi Sánchez-Delgado, Pilar García-Iglesias, Xavier Calvet, Manuel Castro-Fernandez, Felipe Bory, Mercè Barenys, Luis Bujanda, Jacobo M. Lizasoain, María M. Calvo, Sandra Torra
M1123 Prevalence and Molecular Mechanism of Fluoroquinolone Resistance of Helicobacter pylori Strains in Korea Jun-Won Chung, Gin Hyug Lee, Jin-Yong Jeong, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Hwoon-Yong Jung, Jin-Ho Kim
Introduction: Eradication rates of Helicobacter pylori infection with standard triple therapy are disappointingly low, mostly because of the increased rates of clarithromycin resistance. New strategies of treatment are, thus, necessary. Previous studies have shown that potent acid inhibition using esomeprazole increases cure rates with triple therapy and that 10-day treatments are more effective than 7-day ones. In addition, the combination of amoxicillin plus metronidazole at full doses three times a day has been shown to overcome metronidazole resistance, to achieve good eradication rates and its efficacy is not impaired by clarithromycin resistance. Objective: 1) To assess the eradication rate of a new treatment regimen associating potent acid inhibition, amoxicillin and metronidazole. 2) To evaluate the tolerance to this therapeutic regime. Material and methods: 136 patients from 8 different centres were included in a pilot observational study performed under clinical practice conditions. H. pylori status was assessed before treatment by at least one of the following: histology, culture, rapid urease test or urea breath test. Ten-day treatment, including esomeprazol 40 mg b.d., amoxicillin 1 g t.i.d and metronidazol 500 mg t.i.d, with meals was prescribed. H. pylori cure was assessed by urea breath test. Eradication rates and their 95% confidence intervals were calculated both by intention-to-treat and per protocol. Results: A total of 136 patients were enrolled. Mean age was 52.6 ±16 years and 59.6% were men. Indications for treatment were non-investigated dyspepsia (13.6%); functional dyspepsia (18.8%); gastric ulcer (21.8 %) and duodenal ulcer (39.8 %). H. pylori infection was diagnosed by histology, rapid urease test or urea breath test. H. pylori eradication was achieved in 112 out of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intentionto-treat analysis and 88.2% (95% CI: 81.2-92.8) per protocol. The treatment was well tolerated and no major side effects were reported. Only 9 patients complained of mild side effects (the most frequent being metallic taste and diarrhoea). Conclusions: The evaluated combination of esomeprazole, amoxicillin and metronidazole is well tolerated and seems highly effective to eradicate H. pylori. This pilot study warrants the comparison of this new schedule with current standards.
Background: New regimens including newer fluoroquinolones have been developed, due to the increasing resistance of Helicobacter pylori. We aimed to assess the fluoroquinolone resistance rate as well as the mechanisms of resistance in clinical isolates in Korea. Methods: Minimal inhibitory concentration (MIC) values of ciprofloxacin were determined by agar dilution method on 192 H. pylori isolates. Resistant strains (MIC values > 1 μg/ml) were evaluated for the presence of point mutations in the quinolone resistance determining region (QRDR) of the gyrA and gyrB by amplification and nucleotide sequence. Results: Thirtytwo (32/192, 16.6%) of the strains were found resistant to fluoroquinolones. The most common mutations in H. pylori gyrA gene were found at codons corresponding to Asp87 (50.0%), Asn91 (34.3%), Ala88 (6.2%). Two novel gyrA mutations were noted Asp91Asn/ Asp143Glu and Arg130Lys were also detected. Double mutations (Asp481Glu and Arg484Lys) in gyrB were detected in three strains (9.3%). Conclusions: These results suggest that H. pylori resistance to fluoroquinolones is common in the Korea population. The resistance is most likely mediated through amino acid point mutation in gyrA. However, novel mutation is emerging, therefore, further surveillance is required. M1124 Randomized Comparison of One or Two Week Bismuth Based Quadruple Therapy for Salvage Helicobacter pylori Eradication Jun-Won Chung, Hwoon-Yong Jung, Tae-Hoon Oh, Do Hoon Kim, Kwi-Sook Choi, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim Aim: Direct comparisons of one and two week bismuth-based quadruple therapies for salvage Helicobacter pylori eradication are lacking. A randomized study was conducted to compare efficacy, compliance, and adverse effect of two regimens. Methods: One hundred and eighty patients who failed H. pylori eradication were randomized to receive pantoprazole 40mg twice daily, metronidazole 500 mg thrice daily, bismuth subcitrate 300 mg and tetracycline 500 mg four times daily for 7 days (PBMT7) or 14 days (PBMT14). Post-treatment H. pylori status was determined by 13C-urea breath test. Results:The eradication rates were 80.4% (74/92) and 88.6 % (70/79) with PBMT7, and 84.1% (74/88) and 97.1% (68/70) by intentionto-treat (p=0.39) and per-protocol analyses (p=0.10). PBMT14 had more common adverse events than PBMT7 [51.1% (45/88) vs. 32.6% (30/92), p=0.02] Although numerically high drop-out rate was observed in PBMT14 [10.2% (9/88)] than PBMT7 [4.3% (4/92)], there was no statistical difference between two groups (p=0.11). Conclusion: PBMT7 was as effective as PBMT14 with less moderate-severe adverse effect. Therefore, it may be sufficient to use one week quadruple therapy for the salvage H. pylori treatment in Korea.
M1127 Analysis of Related Factors of H. pylori Eradication Therapy Efficiency Liya Zhou, Huang Feng, Yan Xue, XueLing Yang, Sanren Lin Objective:To investigate the related factors of H. pylori eradication therapy efficiency. Materials and methods: A total number of 1603 patients diagnosed as H. pylori infection by WS stain were enrolled and received H. pylori eradication therapy. The 13 C-urea breath test was taken more than 4 weeks after the therapy to assess the efficiency. The general datas, underlying upper gastrointestinal disease, initial treated or retreated ,the therapeutic regimes, and the duration were compared and analyzed statistically. Results: 1.For all patients, H. pylori was eradication rate: 77.9%. 2. The eradication rate of the peptic ulcer group was 88.8%, higher than that of the non-ulcer group (74.8%, P=0.000). 3.The eradication rate of the initial treated group was 78.6%, higher than that of the retreated group (65.2%,P= 0.003). 4.The eradication rate of quadruple therapy was higher than triple therapy, 84.3% and 74% respectively(P=0.000), the eradication rate of sequential therapy was 77.5%.The differenc between triple therapy and sequential therapy, sequential and triple therapy were not significant different.(P=0.497,0.696) 5.In the initial treated group ,the eradication rate of the 14-day was higher than 7-day and 10-day treatment, with the eradication rate 90.2%,75.4% and 81.8% respetively(P=0.004,0.006).There was not significant differenc
S-337
AGA Abstracts
AGA Abstracts
and amoxicillin are found to be equally effective and more safe compared with triple therapy. Therefore, dual therapy will be one of option as the first line treatment regimen of H. pylori eradication.