Ten-Year Trend of the Cumulative Helicobacter pylori Eradication Rate for the 'Japanese Eradication Strategy'

Background/Aims: In Japan, a systematic eradication strategy for Helicobacter pylori has been constructed, and consists of a proton pump inhibitor/amoxicillin and clarithromycin (PPI/AC) therapy as the first-line regimen and proton pump inhibitor/amoxicillin and metronidazole (PPI/AM) therapy as the second-line regimen. The cumulative rate of H. pylori eradication has not been reported. Therefore, we investigated the annual and cumulative eradication rate to verify the efficacy of the 'Japanese eradication strategy'. Methods: Patients who received first-line PPI/AC therapy and, if necessary, second-line PPI/AM therapy between 2000 and 2009 were retrospectively analyzed. The annual cumulative eradication rate was calculated. Data were subjected to intention-to-treat analysis. Results: PPI/AC was administered to 1973 patients (male n = 1,162, female n = 811; mean age: 55.8 years, range: 15-87), and 250 patients received PPI/AM. The eradication rate for the PPI/AC regimen was 65.3%, and it gradually but significantly decreased over 10 years (p < 0.05). For the PPI/AM regimen, the eradication rate was 84.0%, with no change in the annual eradication rate. The cumulative eradication rates were 76.0% in intention-to-treat analysis and 98.4% in per-protocol analysis, respectively, which provided a consistent annual eradication rate without decreases in effectiveness. Conclusion: Although the eradication rate for the first-line PPI/AC regimen decreased overtime, the 'Japanese eradication strategy' provided a sufficient eradication rate. (C) 2013 S. Karger AG, Basel