Comparison of five different treatment regimens for H. pylori eradication

Treatment response to five different H. Pylori eradication regimens were evaluated to see which is the best regimen in our setup.

Patients presenting with upper GI symptoms of acid peptic disease underwent upper GI endoscopy and an antral CLO test. All those with a positive CLO test were included in the study. The study was carried out over a year and one trial was followed by another. The treatment regimens comprised of (1) Omeprazole 20 mg once a day, colloidal bismuth subcitrate 120 mg three times a day, Metronidazole 200 mg three times a day (18 cases). (2) Colloidal bismuth subcitrate three times a day, furazolidone 100 mg three times a day, metronidazole 200 mg three times a day (28 cases). (3) Omeprazole 20 mg once a day, Clarithromycin 500 mg twice a day (21 cases). (4) Lansoprazole 30 mg once a day, Amoxycillin 500 mg three times a day (21 cases). (5) Lansoprazole once a day, Amoxycillin 500 mg three times a day and Roxithromycin 150 mg twice a day (14 cases). Therapy for all 5 groups comprised of 14 days. Endoscopy and CLO test were done prior to the entry in the trial and at 28 days to see the response.

Meta analysis was done for all the 5 regimens. For the purpose of analysis patients were divided into 2 groups, i.e., those with peptic ulcer and positive CLO (peptic ulcer disease (PUD) and those without peptic ulcer but positive CLO test (Non ulcer dyspepsia (NUD). PUD was seen in 14 of 18 cases in group 1, 18 of 28 cases in group 2, 16 of 21 cases in group 3, 6 of 21 cases in group 4 and 3 of 14 cases in group 5. In PUD after 14 days of therapy, lesions healed and CLO became negative in 50% cases each in group 1 and 2, 56% in group 3, 83% in group 4 and all in group 5, while in NUD, 25%, 60%, 80%, 47% and 82% respectively showed H. Pylori eradication.

Of the different therapies one proton pump inhibitor with two antibiotics gave best results in ulcer healing and H. pylori eradication in ulcer and non ulcer dyspepsia.