The influence of pretreatment on cure rates of Helicobacter pylori eradication.
BACKGROUND
Many patients treated for H. pylori infection have been taking a proton pump inhibitor beforehand. There is conflicting evidence whether pretreatment influences the efficacy of H. pylori eradication. The aim of this study was to investigate the influence of pretreatment on cure rates of H. pylori eradication.


METHODS
Patients with H. pylori positive peptic ulcer disease or functional dyspepsia were treated with two-day quadruple therapy (lansoprazole 30 mg twice daily, and colloidal bismuth subcitrate 120 mg, tetracycline 250 mg and metronidazole 250 mg, all eight times a day). Patients were randomised to receive either three-day pretreatment with lansoprazole 30 mg twice daily or no pretreatment. H. pylori was diagnosed using CLO, histology and culture.


RESULTS
Twenty-five (66%) of 38 patients with pretreatment and 32 (84%) of 38 patients without pretreatment were cured (p=0.06). After adjustment for diagnosis, smoking status and metronidazole resistance the influence of pretreatment became slightly less pronounced (OR 0.44, 95% CI 0.1-1.7). Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication than smokers and patients with functional dyspepsia, respectively (adjusted odds ratios: 4.79 (1.2-19) and 4.32 (1.0-18)).


CONCLUSIONS
This two-day quadruple therapy reached an overall cure rate of 75%. Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication. Three-day pretreatment with a proton pump inhibitor may decrease cure rates of this two-day quadruple therapy.
Department of Gastroenterology and Hepatology (547), University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands. m.janssen@mdl.umcn.nl
M J R
MJ
Janssen
R J F
RJ
Laheij
J B M J
JB
Jansen
W A
WA
de Boer
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001729:Bismuth / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy*; D013752:Tetracycline / Q000008:administration & dosage
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D008795:Metronidazole; D013752:Tetracycline; D009853:Omeprazole; D001729:Bismuth