Preoperative versus postoperative Helicobacter pylori eradication therapy in gastric cancer patients: a randomized trial.
OBJECTIVE
Helicobacter pylori (H. pylori) eradication is strongly recommended for gastric cancer patients who undergo subtotal gastrectomy. The efficacy of proton pump inhibitor-based triple therapy for H. pylori eradication has not been adequately assessed in the gastric remnant. The aim of this study was to compare the efficacy of postoperative versus preoperative H. pylori eradication therapy.


METHODS
A total of 138 distal gastric cancer patients with H. pylori infection were randomized to receive either preoperative (preop, N = 68) or postoperative (postop, N = 70) proton pump inhibitor-based triple therapy for H. pylori eradication. The regimen consisted of rabeprazole 10 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily for 7 days. Eradication was assessed by rapid urease test and histology 12 wk after surgery.


RESULTS
By intention-to-treat (ITT) analysis, H. pylori eradication rates were 84.6% (95% CI 73.5-92.4) in the preop group and 83.1% (95% CI 71.7-91.2) in the postop group (P= 0.99). By per protocol (PP) analysis, the rates were 87.3% (95% CI 76.5-94.4) in the preop group and 86.9% (95% CI 75.8-94.2) in the postop group (P= 0.99). In the postop group, eradication rates did not differ with reconstruction method (Billroth I vs II, 80.4%[95% CI 66.1-90.6]vs 89.5%[95% CI 66.9-98.7] by ITT analysis (P= 0.49), and 85.7%[95% CI 71.5-94.6]vs 89.5% (95% CI 66.9-98.7) by PP analysis, P= 0.99).


CONCLUSIONS
In distal gastric cancer patients, the effect of proton pump inhibitor-based triple therapy for H. pylori eradication was not different whether given postoperatively or preoperatively.
Kim
Chan Gyoo
CG
Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Song
Ho June
HJ
Kook
Myeong-Cherl
MC
Hong
Eun Kyung
EK
Park
Sohee
S
Lee
Jong Yeul
JY
Lee
Jun Ho
JH
Ryu
Keun Won
KW
Kim
Young-Woo
YW
Bae
Jae-Moon
JM
Choi
Il Ju
IJ
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D006180:Proton-Translocating ATPases / Q000037:antagonists & inhibitors; D064750:Rabeprazole; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D004791:Enzyme Inhibitors; D064750:Rabeprazole; D000658:Amoxicillin; D006180:Proton-Translocating ATPases; D017291:Clarithromycin