title: Trends of second-line eradication therapy for Helicobacter pylori in Japan: a multicenter study in the Tokyo metropolitan area.
abstract: BACKGROUND
  In Japan, the eradication rate of first-line therapy for Helicobacter pylori (H. pylori) with a proton pump inhibitor (PPI), amoxicillin (AMPC) and clarithromycin (CAM) has been decreasing because of a high prevalence of CAM resistance. A possible decrease of the eradication rate for second-line therapy with a PPI, AMPC and metronidazole (MNZ) is of concern. The aim of this study is to assess the trends in second-line eradication therapy for H. pylori in Japan.
  
  
  METHODS
  We accumulated data retrospectively on patients administered second-line eradication therapy for Helicobacter pylori with a PPI, AMPC, and MNZ for 1 week after failure of first-line eradication therapy with a PPI, AMPC and CAM at 15 facilities in the Tokyo metropolitan area in Japan from 2007 to 2011. Trends for second-line eradication rates in modified intention-to-treat (ITT) analyses were investigated. Second-line eradication rates were categorized by three PPIs (rabeprazole (RPZ), lansoprazole (LPZ) or omeprazole (OMZ)) and evaluated.
  
  
  RESULTS
  We accumulated data on 1373 patients. The overall second-line eradication rate was 92.4%. Second-line eradication rates in 2007, 2008, 2009, 2010 and 2011 were 97.7, 90.6, 94.5, 91.8 and 91.8%, respectively, with no significant trends revealed. Second-line eradication rates categorized by three PPIs for the entire 5-year period were 91.6, 93.4 and 92.4% (RPZ, LPZ and OPZ, respectively) with no significant differences among the three PPIs.
  
  
  CONCLUSIONS
  From 2007 to 2011, there were no significant trends in the second-line eradication rates and the rates remained consistently high. From the viewpoint of high prevalence of CAM resistance in Japan, triple therapy with PPI, AMPC and MNZ may be a better strategy for first-line therapy compared to triple therapy with PPI, AMPC and CAM.
authors.affiliation: Tokyo HP Study Group, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Asaoka
authors.forename: Akihito
authors.initials: A
authors.lastname: Nagahara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsuhisa
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kengo
authors.initials: K
authors.lastname: Tokunaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.forename: Kohei
authors.initials: K
authors.lastname: Kawakami
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Suzuki
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nishizawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Kurihara
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ito
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Fumio
authors.initials: F
authors.lastname: Omata
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Mizuno
authors.forename: Akira
authors.initials: A
authors.lastname: Torii
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ohkusa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mine
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sakaki
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D060740:Disease Eradication; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016480:Helicobacter pylori / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D012189:Retrospective Studies; D014041:Tokyo / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D064747:Lansoprazole; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole
keywords: 7-day triple therapy; Helicobacter pylori; Second-line therapy; metonidazole; proton pump inhibitor