POSSIBILITIES FOR HELICOBACTER-PYLORI SUPPRESSION ERADICATION

Objective: To review recent advances in suppression and eradication of Helicobacter pylori and present latest data on optimization of triple therapy. Design: Review of recent advances in H. pylori eradication and report of a single centre, prospective, single-blinded, randomized trial of H. pylori eradication using either standard triple therapy or frequent low dose triple therapy. Setting: Outpatient endoscopic clinic treating patients referred from general practitioners. Patients: Referred patients with dyspepsia, found to have either non-ulcer dyspepsia or duodenal ulcer with absence of gastric carcinoma, coagulopathy or drug allergy. Consecutive patients were randomly assigned either four times daily standard or five times daily lower dose triple therapy with 130 and 128 patients, respectively, becoming available for analysis at repeat endoscopy. Interventions: Endoscopic (urease test and histology) detection of H. pylori at 0 and 6 weeks. Therapy (for 14 days) with either colloidal bismuth subcitrate (CBS, De-Nol), tetracycline 500 mg, metronidazole 250 mg four times daily or CBS, tetracycline 250 mg, metronidazole 200 mg five times daily. Main outcome: One hundred and twenty out of 130 patients (92%) eradicated H. pylori using four times daily therapy while 123 out of 128 (96%) eradicated with five times daily treatment (NS). A significant reduction in side effects was recorded (P < 0.01). Conclusions: Optimized low dose five times daily triple therapy is associated with reduced side effects without sacrificing the high efficacy of H. pylori eradication.