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Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Dual vs. triple therapy for childhood Helicobacter pylori gastritis: a double-blind randomized multicentre trial
Giuseppina Oderda1, Daniela Marinello, Pietro Lerro
1Pediatric Department of the University of Novara, Italy. oderda@med.unipmn.it
Insights
Eradicating Helicobacter pylori in children using one-week triple or dual therapy showed similar success rates. While symptoms improved initially, epigastric pain recurred in most infected children within two years.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Trials
Background:
- Limited data exists on the efficacy of Helicobacter pylori (H. pylori) eradication treatments in pediatric gastritis.
- H. pylori infection is a common cause of chronic gastritis in children, leading to dyspeptic symptoms.
Purpose of the Study:
- To compare the efficacy of a one-week triple therapy (lansoprazole, amoxicillin, tinidazole) versus dual therapy (amoxicillin, tinidazole) for H. pylori eradication in children.
- To assess the long-term effectiveness of eradication in resolving upper gastrointestinal symptoms.
Main Methods:
- A double-blind, randomized, multicenter trial involving 43 children with H. pylori gastritis.
- Patients received either triple therapy or dual therapy for one week, with H. pylori eradication confirmed by 13C-urea breath tests at 6 weeks and 6 months.
- Symptom diaries and telephone interviews up to two years post-treatment evaluated symptom resolution and recurrence.
Main Results:
- Similar H. pylori eradication rates were observed for both triple (72.7%) and dual therapy (71%) at 6 months.
- Dyspeptic symptoms improved in most children shortly after treatment, regardless of eradication status.
- Epigastric pain recurred in a majority of H. pylori-positive children within two years, with significant severity in some cases.
Conclusions:
- One-week triple and dual antibiotic therapies demonstrate comparable H. pylori eradication rates in children.
- Initial symptom relief is common post-treatment, but sustained resolution is less likely in children with persistent H. pylori infection.
- Recurrence of epigastric pain highlights the need for effective, long-term management strategies for H. pylori-associated gastritis in pediatric patients.
Background:
Data on the efficacy of eradication treatment for Helicobacter pylori gastritis in children are scarce.
Aim:
To evaluate the efficacy of triple therapy with lansoprazole plus amoxicillin and tinidazole vs. dual therapy with amoxicillin and tinidazole in a double-blind randomized multicentre trial, and the usefulness of eradication in terms of long-term symptom resolution.
Subjects:
We enrolled 43 consecutive children undergoing endoscopy for upper gastrointestinal dyspepsia with H. pylori gastritis. They underwent a 13C-urea breath test, completed a 2-week symptom diary card, and were randomized. Treatment was given in a Redidose box (Redidose Company Ltd., Brighton, UK) containing either lansoprazole-amoxicillin-tinidazole (triple therapy) or placebo plus amoxicillin-tinidazole (dual therapy) for 1 week. The completion of a 2-week symptom diary card and the performance of a breath test were repeated 6 weeks and 6 months after the end of therapy. One to two years later, a structured telephone interview was conducted with 36 of the children.
Results:
According to the breath test, 6 weeks after the end of therapy H. pylori was eradicated in 15 of 22 children on triple therapy [68.2%; 95% confidence interval (CI) = 45-88] and in 15 of 21 children on dual therapy (71%; 95% CI = 48-89; not significant), and 6 months after the end of therapy it was eradicated in 16 of 22 children on triple therapy (72.7%) and in 15 of 21 children on dual therapy. Six months after therapy, symptoms were analysed in 11 H. pylori-positive and 31 H. pylori-negative children, and it was found that dyspeptic symptoms had disappeared or improved in both groups, with no difference between them. One to two years later, 36 children were interviewed. Epigastric pain had recurred in three of 26 H. pylori-negative and in seven of 10 H. pylori-positive children (p = .001); in three of the latter, pain was severe and required additional treatment.
Conclusion:
One-week triple or dual therapy with two antibiotics achieved similar eradication rates. Soon after treatment, symptoms disappeared or improved in most children irrespective of eradication, but epigastric pain recurred in the majority of the still-infected children within 2 years.
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