title: A comparison between standard triple therapy and sequential therapy on eradication of Helicobacter pylori in uremic patients: A randomized clinical trial.
abstract: BACKGROUND
  The prevalence of peptic ulcer disease in hemodialysis dependent patients is higher than the general population. These patients are also more prone to upper gastrointestinal bleeding. The aim of this study was to compare the effects of a standard triple therapy with a sequential therapy on Helicobacter pylori eradication in azotemic and hemodialysis patients.
  
  
  METHODS
  Forty nine hemodialysis and azotemic patients, naïve to H. pylori treatment, were randomized into two groups to receive either standard triple therapy (pantoprazole 40 mg, amoxicillin 500 mg and clarithromycin 250 mg twice a day for 14 days) or a sequential therapy (pantoprazole 40 mg for 10 days, amoxicillin 500 mg twice a day for the first 5 days and clarithromycin 250 mg + tinidazole 500 mg twice a day just during the second 5 days). H. pylori eradication was evaluated by fecal H. pylori antigen assessment 8 weeks after the treatment.
  
  
  RESULTS
  Of 49 patients, 45 patients (21 in triple therapy group and 24 in the sequential group) completed the study. Based on intention to treat analysis, H. pylori eradication rates were 66.7% (95% confidence interval [CI]: 47.8-85.5%) in standard triple therapy group and 84% (95% CI: 69.6-98.3%) in sequential therapy group (P = 0.34). Per-protocol (PP) eradication rates were (95% CI: 76.2%. 6-89.3%) 54 and 87.5% (95% CI: 68.8-95.5%), respectively (P = 0.32).
  
  
  CONCLUSIONS
  According to Maastricht III consensus report, the results of our study showed that sequential therapy might be a better choice compared with the standard triple therapy in azotemic and hemodialysis patients Iran. We propose to assess the effects of shorter-duration sequential therapy (less than 10 days) for H. pylori eradication.
authors.affiliation: Department of Nephrology, Imam Khomeini Hospital, Biology Molecular and Cellular Research Center, Sari, Iran ; Department of Immunology, Biology Molecular and Cellular Research Center, Sari, Iran.
authors.forename: Atieh
authors.initials: A
authors.lastname: Makhlough
authors.affiliation: Department of Gastroenterology, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hafez
authors.initials: H
authors.lastname: Fakheri
authors.affiliation: Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Ahmad Ramezani
authors.initials: AR
authors.lastname: Farkhani
authors.affiliation: Department of Nephrology, Imam Khomeini Hospital, Sari, Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Seddighi
authors.affiliation: Department of Gastroenterology, Imam Khomeini Hospital, Sari, Iran.
authors.forename: Seyed Vahid
authors.initials: SV
authors.lastname: Hossieni
authors.affiliation: Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khademloo
authors.affiliation: Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Bari
keywords: Azotemic; Helicobacter pylori; hemodialysis; sequential; triple therapy