Open Access<p>First-line <em>Helicobacter pylori</em> eradication rates are significantly lower in patients with than those without type 2 diabetes mellitus</p>
Author(s) -
ChihChien Yao,
ChungMou Kuo,
ChienNing Hsu,
ShihCheng Yang,
ChengKun Wu,
WeiChen Tai,
ChihMing Liang,
KengLiang Wu,
Chih-Fang Huang,
Kuo-Wei Bi,
ChenHsiang Lee,
SengKee Chuah
Publication year - 2019
Publication title -
infection and drug resistance
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.033
H-Index - 39
ISSN - 1178-6973
DOI - 10.2147/idr.s194584
Subject(s) - gastroenterology , helicobacter pylori , medicine , confidence interval , odds ratio , levofloxacin , amoxicillin , clarithromycin , breath test , body mass index , univariate analysis , antibiotics , multivariate analysis , biology , microbiology and biotechnology
Purpose: To assess the difference of the first-line therapy for Helicobacter pylori in patients with or without type 2 diabetes (DM) and to investigate the clinical factors influencing treatment outcomes. Patients and methods: In total, 719 patients with H. pylori infection were treated with 7-day standard first-line triple therapy, of whom 182 did and 537 did not have DM. Propensity score matched at a 1:2 ratio - for age, sex and body mass index was performed for the two groups, yielding a DM group with 147 patients and a non-DM group with 249 matched controls for analysis. Urea breath test was performed 6-8 weeks after treatment. Clinical and laboratory parameters were collected for identifying factors associated with failed eradication. Results: H . Pylori was eradicated in 74.1% (95% confidence interval [CI] =66.2-81.0) of the DM group and 85.3% (95% CI =80.8-89.4) of the non-DM group ( p =0.005). Of 51 gastric biopsy samples cultured for H. pylori , 41 were positive. In the DM group, the rates of resistance to amoxicillin, clarithromycin, levofloxacin, and tetracycline were 0%, 50.0%, 50.0% and 0%, respectively. In the non-DM group, the comparable proportions were 2.9%, 17.1%, 22.9%, and 0%, respectively. Univariate analysis revealed that DM (Odds ratio [OR], 1.771, 95% CI, 1.167-2.668, p =0.006), clarithromycin resistance (OR, 15.273; 95% CI, 1.687-138.269; p =0.015), and amoxicillin resistance (OR, 4.672; 95% CI, 2.431-8.979; p <0.001) were independently associated with failure to eradicate H. pylori . Multivariate analysis showed that clarithromycin resistance was the major factor independently associated with failure of eradication (OR, 25.472; 95% CI, 1.549-418.956; p =0.023). Conclusions: First-line H. pylori eradication rates in patients with DM were significantly lower than in those without DM, although neither group achieved >90% eradication.