title: Efficacy of serology driven "test and treat strategy" for eradication of H. pylori in patients with rheumatic disease in the Netherlands.
abstract: The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000-2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9-20%) and in the placebo group 79% (123/155, 95% CI 72-85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18-63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline.
authors.affiliation: Department of Rheumatology, VU University Medical Center Amsterdam, P.O. Box 7057, Amsterdam, The Netherlands. marleen.deleest@planet.nl
authors.forename: H T J I
authors.initials: HT
authors.lastname: de Leest
authors.forename: K S S
authors.initials: KS
authors.lastname: Steen
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
authors.forename: M A F J
authors.initials: MA
authors.lastname: van de Laar
authors.forename: A M
authors.initials: AM
authors.lastname: Huisman
authors.forename: S W
authors.initials: SW
authors.lastname: Kadir
authors.forename: H H M L
authors.initials: HH
authors.lastname: Houben
authors.forename: P J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: Y J
authors.initials: YJ
authors.lastname: Debets-Ossenkopp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000907:Antibodies, Bacterial / Q000097:blood; D001706:Biopsy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006651:Histocytochemistry; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010919:Placebos / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012216:Rheumatic Diseases / Q000150:complications*; D012699:Serology / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D010919:Placebos; D054328:Proton Pump Inhibitors