title: The impact of bismuth addition to sequential treatment on Helicobacter pylori eradication: A pilot study.
abstract: The success of the current anti-Helicobacter pylori (H. pylori) treatment protocols is reported to decrease by years, and research is needed to strengthen the H. pylori eradication treatment. Sequential treatment (ST), one of the treatment modalities for H. pylori eradication, includes amoxicillin 1 gr b.i.d and proton pump inhibitor b.i.d for first 5 days and then includes clarithromycin 500 mg b.i.d, metronidazole 500 mg b.i.d and a proton pump inhibitor b.i.d for remaining 5 days. In this study, we investigated efficacy and tolerability of bismuth addition in to ST. We included patients that underwent upper gastrointestinal endoscopy in which H. pylori infection was diagnosed by histological examination of antral and corporal gastric mucosa biopsy. Participants were randomly administered ST or bismuth containing ST (BST) protocols for the first-line H. pylori eradication therapy. Participants have been tested by urea breath test for eradication success 6 weeks after the completion of treatment. One hundred and fifty patients (93 female, 57 male) were enrolled. There were no significant differences in eradication rates for both intention to treat population (70.2%, 95% confidence interval [CI]: 66.3-74.1% vs. 71.8%, 95% CI: 61.8-81.7%, for ST and BST, respectively, p>0.05) and per protocol population (74.6%, 95% CI: 63.2-85.8% vs. 73.7%, 95% CI: 63.9-83.5% for ST and BST, respectively, p>0.05). Despite the undeniable effect of bismuth, there may be several possible reasons of unsatisfactory eradication success. Drug administration time, coadministration of other drugs, possible H. pylori resistance to bismuth may affect the eradication success. The addition of bismuth subcitrate to ST regimen does not provide significant increase in eradication rates.
authors.affiliation: Kecioren Research and Training Hospital, Department of Gastroenterology, Ankara, Turkey. sbuyuktemiz@yahoo.com.
authors.forename: Sebahat
authors.initials: S
authors.lastname: Basyigit
authors.forename: Ayse
authors.initials: A
authors.lastname: Kefeli
authors.forename: Ferdane
authors.initials: F
authors.lastname: Sapmaz
authors.forename: Abdullah Ozgür
authors.initials: AO
authors.lastname: Yeniova
authors.forename: Zeliha
authors.initials: Z
authors.lastname: Asilturk
authors.forename: Murat
authors.initials: M
authors.lastname: Hokkaomeroglu
authors.forename: Metin
authors.initials: M
authors.lastname: Uzman
authors.forename: Yasar
authors.initials: Y
authors.lastname: Nazligul
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use; D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001729:Bismuth / Q000009:adverse effects / Q000627:therapeutic use*; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010865:Pilot Projects; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D001729:Bismuth