title: Modified sequential therapy vs quadruple therapy as initial therapy in patients with Helicobacter infection.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of modified sequential therapy and to compare modified sequential therapy with standard quadruple therapy for Helicobacter pylori (H. pylori) eradication.
  
  
  METHODS
  In total, 200 consecutive patients who were diagnosed with H. pylori-infected chronic gastritis by electronic endoscopy and rapid urease testing from December 2012 to October 2013 were enrolled in this study. The patients had not previously received H. pylori eradication treatment, and were randomized into two groups. The patients in Group A (n = 101) were treated with ilaprazole + bismuth potassium citrate + amoxicillin and clavulanate potassium + levofloxacin, and the patients in Group B (n = 99) were administered a modified sequential therapy composed of ilaprazole at 5 mg bid and amoxicillin and clavulanate potassium at 914 mg for the first five days followed by ilaprazole at 5 mg bid, furazolidone at 100 mg bid and levofloxacin at 500 mg qid for the next five days. Four to six weeks after the end of treatment, a 14C-urea breath test was performed for all the subjects to confirm the eradication of H. pylori. The intention-to-treat and per-protocol eradication rates were determined.
  
  
  RESULTS
  A total of 190 of the 200 patients completed the study. All 200 patients were included in the intention-to-treat analysis, whereas 190 patients were included in the per-protocol analysis. In the intention-to-treat analysis, the rates of H. pylori eradication in Groups A and B were 85.15% (86/101) and 81.82% (81/99), respectively. In the per-protocol analysis, the H. pylori eradication rates in Groups A and B were 88.66% (86/97) and 87.09% (81/93), respectively. No significant difference was observed (χ(2) = 0.109, P = 0.741) in the eradication rate between Groups A and B. The rates of adverse effects observed in the groups were similar at 6.19% (6/97) for Group A and 7.53% (7/93) for Group B (P > 0.05). No mortality or major morbidities were observed in any of the patients. Symptomatic improvements in the presentation of stomachache, acid regurgitation, and burning sensation were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Ilaprazole-based 10-d standard quadruple therapy does not offer an incremental benefit over modified sequential therapy for the treatment of H. pylori infection, as both treatment regimens appear to be effective, safe, and well-tolerated as initial treatment options.
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Liao
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Gao-Hui
authors.initials: GH
authors.lastname: Nong
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Mei-Zu
authors.initials: MZ
authors.lastname: Chen
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Xue-Ping
authors.initials: XP
authors.lastname: Huang
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Yun-Yan
authors.initials: YY
authors.lastname: Cong
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Yi-Ying
authors.initials: YY
authors.lastname: Huang
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Bai-He
authors.initials: BH
authors.lastname: Wu
authors.affiliation: Xiao-Min Liao, Yi-Ying Huang, Bai-He Wu, Jin-Qi Wei, Department of Gastroenterology, the 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Jin-Qi
authors.initials: JQ
authors.lastname: Wei
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001944:Breath Tests; D002681:China; D002908:Chronic Disease; D019818:Clavulanic Acid / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005756:Gastritis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D019818:Clavulanic Acid; C119615:ilaprazole; D000658:Amoxicillin; C002791:bismuth tripotassium dicitrate
keywords: Chronic gastritis; Helicobacter pylori; Ilaprazole; Initial therapy; Quadruple therapy; Sequential therapy