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Helicobacter pylori eradication and peptic ulcer healing: the impact of deleting the proton pump inhibitor and using a once‐daily treatment
Author(s) -
Wheeldon TU.,
Hoang T. T. H.,
Phung D. C.,
Björkman A.,
Granström M.,
Sörberg M.
Publication year - 2003
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2003.01649.x
Subject(s) - lansoprazole , medicine , tinidazole , clarithromycin , proton pump inhibitor , helicobacter pylori , placebo , gastroenterology , peptic , maintenance therapy , rabeprazole , metronidazole , peptic ulcer , antibiotics , chemotherapy , pathology , microbiology and biotechnology , biology , alternative medicine
Summary Aim: To compare cheaper and simpler once‐daily regimens, with and without a proton pump inhibitor, with standard, twice‐daily, triple therapy. Methods: A randomized, placebo‐controlled, treatment trial in Vietnam allocated 296 Helicobacter pylori ‐infected patients with peptic ulcer of ≥ 5 mm to one of three regimens: (i) twice‐daily: lansoprazole 30 mg, clarithromycin 250 mg and tinidazole 500 mg; (ii) once‐daily: lansoprazole 60 mg, clarithromycin 500 mg and tinidazole 1000 mg; (iii) once‐daily: placebo, clarithromycin 500 mg and tinidazole 1000 mg. H. pylori status was assessed by culture and immunoblot, ulcer healing by endoscopy and side‐effects by structured questionnaires. Results: Per protocol eradication ( N = 256) was higher with standard therapy (87%) than with once‐daily therapy (72%), and both were better than once‐daily therapy without proton pump inhibitor (39%). Per protocol ulcer healing after standard therapy (83%) was not significantly better than that after once‐daily therapy (73%), but better than that after therapy without proton pump inhibitor (65%). Side‐effects were reported at similar rates in all groups. Conclusions: Proton pump inhibitor was needed for optimal eradication and ulcer healing. Twice‐daily administration showed improved success rates when compared with once‐daily therapies. Peptic ulcer healing was achieved even in patients treated with antibiotics only, confirming the central role of H. pylori in the pathophysiology of peptic ulcer disease.