Both high-dose dual therapy (HDDT) and bismuth quadruple therapy (BQT) were able to achieve high results. Helicobacter pylori (H pyloriExcision rates according to study results presented in Gastroenterology Week 2021.
BQT is recommended as a standard first-line or rescue system for H pylori eradication. However, a higher incidence of adverse events with BQT might reduce compliance and efficacy. Conversely, HDDT is a simpler system with low antibiotic resistance and potentially high efficacy.
Researchers compared HDDT’s effectiveness with its adverse events and its compliance with BQT as first-line or rescue regimens. Additionally, the investigators explored the factors that might influence H pylori eradication.
A total of 2,672 patients were evaluated, and 1,020 patients were evaluated H pylori Infection was recorded in the study. Prior to treatment, all study participants had upper endoscopy with a biopsy to test for histopathology / culture / antibiotic sensitivity (electronic test).
In this randomized, multicenter study, patients in both first-line treatment (n = 576) and rescue therapy (n = 444) were randomized to receive HDDT (20 mg of rabeprazole 4 times daily and 750 mg of amoxicillin 4 times daily for 14 days). Or BQT (20 mg rabeprazole twice daily, 300 mg tribotassium diacetate bismuth 4 times daily, 250 mg metronidazole 4 times daily and 500 mg tetracycline 4 times daily for 10 days)
To reduce the incidence of dropouts due to adverse events, a 10-day BQT regimen was chosen. All patients were required to complete a set of standardized questionnaires. These questionnaires included dietary habits, adverse events, and drug compliance. The investigators used polymerase chain reaction restriction fraction length polymorphism (PCR-RFLP) to analyze CYP 2C19 genotypes. They used C13– Urea breath tests 4-8 weeks after treatment to determine H pylori eradication.
The ablation intention to treat (ITT) rates for first-line treatments were 95.8% (276/288; 95% CI, 93.5-98.1) with HDDT and 91.7 (264/288; 95% CI, 88.5-94.9) with BQT. ITT ablation rates for rescue treatments were 91.0% (202/222; 95% CI, 87.2-94.7) with HDDT and 88.3% (196/222; 95% CI, 84.1-92.5) with BQT.
The researchers noted significant differences in adverse events between the two groups (HDDT 27% versus BQT 65%; s <.001).
The rates of resistance (first line versus rescue groups) for amoxicillin, metronidazole, tetracycline, clarithromycin, and levofloxacin were as follows: 0.6% versus 0.9%, 30% versus 41%, 0.6% versus 0.9%, 18% versus 75%, and 19% versus 39%, respectively.
The effectiveness of HDDT was significantly reduced by resistance to amoxicillin and a high-acid diet (i.e., consumption of highly acidic and spicy foods, drinking alcohol or tea during treatment). In contrast, the results of BQT treatment were significantly affected by metronidazole resistance, tetracycline resistance, and poor drug compliance.
The study authors concluded that both HDDT and BQT were able to achieve a high percentage H pylori Eradication rates. However, HDDT was better tolerated and available worldwide as compared to BQT. Hence, HDDT is an excellent first-line or rescue system choice for H pylori infection. However, a high-acid diet may significantly reduce the effectiveness of HDDT.
Tong CC, Hu CT, Lin CJ, and others. Efficacy of high-dose dual therapy and quadruple bismuth therapy in first-line eradication and rescue of H.pylori – a final report of a multicenter randomized control study. Filed at: Digestive Diseases Week Annual Meeting. May 21-23, 2021. Abstract 594.
This article originally appeared Gastroenterology Consultant