Dual therapy for third-line Helicobacter pylori eradication and urea breath test prediction

作     者：Toshihiro Nishizawa Hidekazu Suzuki Takama Maekawa Naohiko Harada Tatsuya Toyokawa Toshio Kuwai Masanori Ohara Takahiro Suzuki Masahiro Kawanishi Kenji Noguchi Toshiyuki Yoshio Shinji Katsushima Hideo Tsuruta Eiji Masuda Munehiro Tanaka Shunsuke Katayama Norio Kawamura Yuko Nishizawa Toshifumi Hibi Masahiko Takahashi 

作者机构：Division of Gastroenterology National Hospital Organization Tokyo Medical CenterTokyo 1528902 Japan Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of MedicineTokyo 1608582 Japan Division of Gastroenterology National Hospital Organization Kyoto Medical CenterKyoto 6128555 Japan Division of Gastroenterology National Kyushu Medical CenterFukuoka 8108563 Japan Division of Gastroenterology National Hospital Organization Fukuyama Medical CenterFukuyama 7208520 Japan Division of Gastroenterology National Hospital Organization Kure Medical CenterKure 7370023 Japan Division of Gastroenterology National Hospital Organization Hakodate Medical CenterHakodate 0418512 Japan Division of Gastroenterology National Hospital Organization Maizuru Medical CenterMaizuru 6258502 Japan Division of Gastroenterology National Hospital Organization Higashihiroshima Medical CenterHigashihiroshima 7390041 Japan Division of Gastroenterology National Hospital Organization Sendai Medical CenterSendai 9838520 Japan Division of Gastroenterology National Hospital Organization Osaka Medical CenterOsaka 5400006 Japan Division of Gastroenterology National Hospital Organization Ureshino Medical CenterUreshino 8430393 Japan Division of Gastroenterology National Hospital Organization Osaka Minami Medical CenterKawachinagano 5868521 Japan Division of Gastroenterology National Hospital Organization Fukuoka Higashi Medical CenterKoga 8113195 Japan Division of Gastroenterology National Hospital Organization Yonago Medical CenterYonago 6838518 Japan Division of Gastroenterology National Hospital Organization Disaster Medical CenterTachikawa 1900014 Japan Pharmaceutical Department National Center for Global Health and MedicineTokyo 1658655 Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第21期

页      面：2735-2738页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by A grant from the National Hospital Organization No. H21-NHO-01 

主　　题：Helicobacter pylori   Amoxicillin  Dual therapy  Eradication  Urea breath test 

摘      要：We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)- AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to followup. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.