title: Non-bismuth quadruple therapy for first-line Helicobacter pylori eradication: A randomized study in Japan.
abstract: OBJECTIVE
  To find the way to improve the eradication rate of first-line therapy in Japanese patients.
  
  
  METHODS
  We prospectively compared the effectiveness of 7-d quadruple therapy to standard 7 d triple therapy in Japanese patients infected with Helicobacter pylori (H. pylori). One hundred and nineteen patients were randomly assigned to receive 7-d non-bismuth quadruple therapy with lansoprazole, amoxicillin, clarithromycin and metronidazole (LACM7) or 7-d triple therapy with lansoprazole, amoxicillin and clarithromycin (LAC7). After three months, H. pylori status was analyzed by (13)C-urea breath test. Incidence rates of adverse events were evaluated by use of questionnaires.
  
  
  RESULTS
  By intention-to-treat (ITT) analysis, the eradication rate in the LACM7 group was 94.9%, which was significantly higher than the LAC7 group (68.3%, P < 0.001). Per protocol analysis also showed a significantly higher eradication rate in the LACM7 group (98.3%) than the LAC7 group (73.2%, P < 0.001). Nevertheless, the incidence of serious adverse events did not differ between the two groups (RR: 1.10, 95% CI: 0.70-1.73, P = 0.67).
  
  
  CONCLUSIONS
  Seven day non-bismuth quadruple therapy (LACM7) was superior to standard 7-d triple therapy (LAC7) for first-line eradication.
authors.affiliation: Ayako Yanai, Department of Gastroenterology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki, Kanagawa 213-8587, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Yanai
authors.forename: Kei
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Masao
authors.initials: M
authors.lastname: Akanuma
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda