title: Effect of pretreatment with Lactobacillus gasseri OLL2716 on first-line Helicobacter pylori eradication therapy.
abstract: OBJECTIVE
  Helicobacter pylori eradication clearly decreases peptic ulcer recurrence rates. H. pylori eradication is achieved in 70-90% of cases, but treatment failures due to poor patient compliance and resistant organisms do occur. Lactobacillus gasseri can suppress both clarithromycin-susceptible and -resistant strains of H. pylori in vitro. The aim of this study was to determine the effect of pretreatment with L. gasseri- containing yogurt on H. pylori eradication. We conducted a randomized, controlled clinical trial in patients with H. pylori infection.
  
  
  METHODS
  A total of 229 patients were randomized into either a 1-week triple therapy of rabeprazole (10 mg bid), amoxicillin (750 mg bid), and clarithromycin (200 mg bid) or triple therapy plus L. gasseri-containing yogurt. In the yogurt-plus-triple therapy groups, yogurt containing L. gasseri OLL2716 (112 g) was given twice daily for 4 weeks (3 weeks pretreatment and also 1 week during eradication therapy). Clarithromycin resistance was determined by the detection of a mutation in 23S rRNA using nested polymerase chain reaction and the direct sequencing of DNA from pretreatment feces. H. pylori eradication was diagnosed based on the urea breath test and a stool antigen test after 8 weeks of eradication.
  
  
  RESULTS
  The status of H. pylori susceptibility to clarithromycin was successively determined in 188 out of 229 samples. The rate of infection with clarithromycin-resistant strains of H. pylori was 27.1%. Overall eradication (intention to treat/per protocol) was 69.3/74.5% for the triple-only group, and 82.6/85.6% for the yogurt-plus-triple group (P = 0.018/P = 0.041). Eradication of primary clarithromycin-resistant strains tended to be higher for yogurt-plus-triple therapy than triple-only therapy (38.5 vs 28.0%, respectively, P = 0.458).
  
  
  CONCLUSIONS
  This study confirmed that the major cause of treatment failure is resistance to clarithromycin. A 4-week treatment with L. gasseri-containing yogurt improves the efficacy of triple therapy in patients with H. pylori infection.
authors.affiliation: Gastroenterology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Deguchi
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Nakaminami
authors.forename: Emiko
authors.initials: E
authors.lastname: Rimbara
authors.forename: Norihisa
authors.initials: N
authors.lastname: Noguchi
authors.forename: Masanori
authors.initials: M
authors.lastname: Sasatsu
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Masashi
authors.initials: M
authors.lastname: Matsushima
authors.forename: Jun
authors.initials: J
authors.lastname: Koike
authors.forename: Muneki
authors.initials: M
authors.lastname: Igarashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Ozawa
authors.forename: Ryuki
authors.initials: R
authors.lastname: Fukuda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000898:Antibiosis; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000628:therapy*; D016480:Helicobacter pylori / Q000235:genetics / Q000276:immunology; D006801:Humans; D057194:Intention to Treat Analysis; D007778:Lactobacillus; D008297:Male; D008875:Middle Aged; D064750:Rabeprazole; D015014:Yogurt
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin
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