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Ultimate eradication rate of H elicobacter pylori after first, second, or third‐line therapy in K orea
Author(s) -
Yoon Kichul,
Kim Nayoung,
Nam Ryoung H,
Suh Ji H,
Lee Seonmin,
Kim Jung M,
Lee Ju Y,
Kwon Yong H,
Choi Yoon J,
Yoon Hyuk,
Shin Cheol M,
Park Young S,
Lee Dong H
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12839
Subject(s) - medicine , clarithromycin , metronidazole , helicobacter pylori , gastroenterology , proton pump inhibitor , surgery , antibiotics , microbiology and biotechnology , biology
Background and Aims Resistance rates of H elicobacter pylori to clarithromycin, metronidazole, and quinolone are over 30% in S outh K orea. The aim of this prospective study was to evaluate the ultimate eradication rate of H . pylori after first, second, or third‐line therapy in K orea. Methods A cohort of 2202 patients with H . pylori was treated with proton pump inhibitor ( PPI )‐based triple therapy for seven days. In case of treatment failure or recurrence, moxifloxacin‐based triple therapy ( MA ) or bismuth‐based quadruple therapy ( QUAD ) was randomly given. When the second‐line treatment failed or H . pylori recurred, the unused MA or QUAD was used as a third‐line treatment. Results Eighty‐six patients had recurrence at least once during consecutive lines of treatments. Among 2116 patients (intention‐to‐treat [ ITT ]) without recurrence, 1644 (77.7%, per‐protocol [ PP ]) completely followed our treatment flow. The ITT and PP rates of first‐line treatment were 69.8% and 89.3%. After second line, they reached 78.4% ( ITT ) and 98.4% ( PP ). The “final” eradication rate up to third line treatment were 80.0% (1692/2116) and 99.8% (1641/1644), respectively. Resistance to clarithromycin showed significantly lower eradication rate ( OR 0.358, P < 0.001) than those with susceptible strains in multivariate analysis. However in PP analysis, there was no significant difference in ultimate success rate regarding resistance pattern. Conclusion Final success rate of PP was high, 99.8% in K orea in spite of high antibiotic resistance rates. However, high rate of refusal of further treatment and follow‐up loss made ITT eradication rate low. Proper strategy to improve the treatment adherence is needed.