First Line Helicobacter Pylori Eradication in Dyspeptic Patients

Background Helicobacter pylori (HP) eradication became a challenge due to increasing resistance to antibiotic therapies that had been previously effective. Aim To compare the efficacy and safety of two first-line therapeutic regimens for HP eradication: standard triple therapy (STT) and quadruple concomitant therapy (QCT) for 14 days with high dose of proton pomp inhibitors (PPI) in dyspeptic patients. Methods. We had prospectively enrolled naive patients diagnosed with HP associated dyspepsia. Endoscopy was performed in all patients; the HP infection was diagnosed by rapid urease test. The patients were randomized 1: 1 in two groups: group A received esomeprasole (20mg bid) -clarithromycin -amoxicillin STT for 10 days and group B received QCT (esomeprasole 40mg bid, clarithromycin, amoxicillin, metronidazole) for 14 days. All patients were re-evaluated 6 weeks after eradication by monoclonal stool antigen test. The side effects of the therapy were noticed. Results The sample included 48 females and 32 male patients, with an average age of 50.34 years. In group A the eradication rate was obtained in 27 patients (67.5%), versus 34 (85%) patients in group B (p=0.03). The side effects (nausea, vomiting, diarrhoea) occurred in 7 patients from group A (17.5%) and in 13 patients from group B (32.5%) (p=0.06). The Clostridium difficile infection was noticed in two patients from group B. Conclusions QCT with high dose of PPI and prolonged duration is more effective than STT as first - line HP eradication in dyspeptic patients but has more side effects (including Clostridium difficile infection).