Standard treatment for Helicobacter pylori infection is suboptimal in non-ulcer dyspepsia compared with duodenal ulcer in Chinese.
BACKGROUND
Recent studies suggest that the Helicobacter pylori eradication rate in patients with non-ulcer dyspepsia is lower when compared to patients with peptic ulcer diseases.


OBJECTIVE
The aim of this study was to study the efficacy of triple therapy for H. pylori infection in patients with duodenal ulcer vs. patients with non-ulcer dyspepsia.


METHODS
A total of 582 Chinese patients with proven H. pylori infection were recruited to receive: omeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg all given twice daily for 7 days (OCA regime). Endoscopy with rapid urease test, histology and culture were performed before treatment. Post-treatment H. pylori status was determined by (13)C-urea breath test. Metronidazole, clarithromycin and amoxicillin resistance was defined as minimum inhibitory concentration (MIC) of >8 microg/mL, >1 microg/mL and >1 microg/mL, respectively.


RESULTS
A significantly higher (intention-to-treat/per-protocol) eradication rate was found in patients with duodenal ulcer than those with non-ulcer dyspepsia (91/94% vs. 84/88% respectively, P = 0.011 and P = 0.016). Clarithromycin resistance rate was higher in patients with non-ulcer dyspepsia than those with duodenal ulcer (14% vs. 6%, P = 0.015). Clarithromycin resistance (40% vs. 5%, P < 0.001, OR 12, 95% CI: 5.7-24.3) and the diagnosis of non-ulcer dyspepsia (91% vs. 84%, P = 0.011, OR 2.0, 95% CI: 1.2-3.3) significantly affected the success of H. pylori eradication.


CONCLUSIONS
Clarithromycin resistance accounts for the significantly lower and suboptimal H. pylori eradication rate of OCA regimen in Chinese patients with non-ulcer dyspepsia compared to those with duodenal ulcer.
Wong
W M
WM
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Xiao
S D
SD
Hu
P J
PJ
Wang
W H
WH
Gu
Q
Q
Huang
J Q
JQ
Xia
H H-X
HH
Wu
S M
SM
Li
C J
CJ
Chen
M H
MH
Cui
Y
Y
Lai
K C
KC
Hu
W H C
WH
Chan
C K
CK
Lam
S K
SK
Wong
B C-Y
BC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D044466:Asian People / Q000208:ethnology; D017291:Clarithromycin / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004381:Duodenal Ulcer / Q000208:ethnology / Q000382:microbiology*; D004415:Dyspepsia / Q000208:ethnology / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000208:ethnology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010349:Patient Compliance; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole