Outcome of treatment for Helicobacter pylori infection in the carinthian region
Abstract
Backgrounds: Antimicrobial resistance is the major cause for treatment failure in Helicobacter pylori(HP) infection. In the majority of countries, including Slovenia, the eradication rate of primary therapy is below 80 %. So far we have not have any data about HP infection treatment in Carinthian region.
Methods: We performed a retrospective analysis of medical documentation of all patients treated in our institution for HP infection in 2011 and 2012. Treatment outcome was determined by urea breath test. Basic demographic data of patients, endoscopic findings and histologic diagnosis were analysed together with the treatment regimen chosen and the eradication rates achieved. Secondary resistance rates for anti- microbials were calculated in patients that had culture and sensitivity tests performed because of treatment failure.
Results: Total of 324 patients were included in the analysis (60.2 % female and 39.8 % male, mean age 52.1 years): 111 patients in the year 2011 (52.3 % female and 47.7 % male, mean age 53.0 years) and 213 (64.3 % female and 35.7 % male, mean age 54.1 years); 90.0 % (n = 285) of patients had endoscopic findings of chronic active gastritis, 3.1 % (n = 10) of patients had peptic ulcer disease; 27.8 % (n = 90) of patients had pre-cancerous lesions of gastric mucosa (atrophy or intestinal metaplasia) present on histology.
Seven-day triple therapy with a proton pump inhibitor (PPI), amoxicillin and clarithromycin (PAC) was prescribed in 87.7 % (n = 284) of patients as the first line treatment option, 11.7 % (n = 38) of patient received 7-day triple therapy with PPI, amoxicillin and metronidazole (PAM) and 0.6 % (n = 2) of patients received 7-day triple therapy with PPI, clarithromycin and metronidazole (PCM). The eradication rate with the firstline therapy was 70.7 % intention to treat (ITT) analysis and 70.9 % per protocol (PP) analysis. Cumulative eradication rate for up to four lines of therapy was 89.9 % ITT analysis and 99.7 % PP analysis. Culture and sensitivity tests were performed in 16.4 % (n = 53) of patients. Secondary resistance rates for clarithromycin, metronidazole, levofloxacin, amoxicillin and tetracycline in patients after treatment failure were 84.6 %, 70.0 %, 7.7 %, 2.5 % and 0.0 %, respectively.
Conclusions: The analysis of HP treatment in the Carinthian region in the period between 2011 and 2012 is presented. The success rate of the first-line therapy is at a critically low level. Cumulative eradication rate in the ITT analysis has dropped below 90 %. However, it is still high in the PP analysis, but on the account of longer treatment and higher costs. An optimization of the initial treatment strategies for the HP eradication is needed. Systematic surveillance of antimicrobial resistance of HP in our region as well as in other regions of Slovenia is mandatory.
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References
Cave DR. Transmission and epidemiology of Helicobacter pylori. Am J Med 1996; 100 (5A): 12–8.
Pounder RE, Ng D. The prevalence of Helicobacter pyloriin different countries. Aliment Pharamacol Ther 1995; 9 Suppl 2: 33–9.
Crowe SE, Feldman M, Grover S. Association between Helicobacter pyloriinfection and duodenal ulcer. UpToDate, version 19.3, elektronski medmrežni dostop 9.2.2012.
Jensen PJ, Feldman M, LaMont JT, Grover S. Acute and chronic gastritis due to Helicobacter pylori. UpToDate, version 19.3, elektronski medmrežni dostop 9.2.2012.
DuBois S, Kearney D. Iron-deficiency anemia and Helicobacter pyloriinfection. A review of evidence. Am J Gastroenterol 2005; 100: 453–9.
Franchini M, Cruciani MM, Mengoli CC. Effect of Helicobacter pylorieradication on platelet count in idiopatic trombocitopenic purpura: a systematic review and meta analysis. J Antimicrob Chemoter 2007; 60: 237–46.
Hernando-Harder AC, Booken N, Goerdt S, Singer MV, Hender H. Helicobacter pyloriinfection and dermatologic diseases. Eur J Dermatol 2009; 19: 431–44.
European Helicobacter Study Group. Current European concepts in the menagement of Helicobacter pyloriinfection. The Maastricht consensus Report. Gut 1997; 41: 8–13.
Malfertheiner P, Megraud F, O’Morain C, Hungin APS, Jones R, Axon A et al. Current concepts in the menagement of Helicobacter pyloriinfection–The Maastricht 2–2000 Consensus Report. Aliment Pharmacol Ther 2002; 16: 167–80.
Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D etal. Current concepts in the menagement of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56: 772–81.
Malfertheiner P, Megraud F, O’Morain C, Atherton J, Axon ATR, Bazzoli F et al. Management of Helicobacter pyloriinfection: the Maastricht IV/Florence Consensus Report. Gut 2012; 61: 646–64.
Tepeš B, Križman I. Priporočila za zdravljenje okužbe z bakterijo Helicobacter pyloriv Sloveniji. Zdrav Vestn 1998; 67: 159–62.
Tepeš B, Štabuc B. Priporočila Slovenskega zdru-ženja za gastroenterologijo in hepatologijo za zdravljenje okužbe z bakterijo Helicobacter pylori. Zdrav Vestn 2011; 80: 647–56.
Gubina M, Tepeš B, Vidmar G, Ihan A, Logar J, Wraber-Herzog B et al. Prevalenca protiteles proti bakteriji Helicobacter pyloriv Sloveniji v letu 2005. Zdrav Vestn 2006; 75: 169–73.
Tepeš B, Ojsteršek Z. Uspešnost zdravljenja okuž-be z bakterijo Helicobacter pyloriv Sloveniji v letu 2008. Zdrav Vestn 2010; 79: 19–24.
Jeverica S, Tepeš B, Ihan A, Skvarč M. Primarna odpornost bakterije Helicobacter pylori. Zdrav Vestn 2010; 79: 25–30.
Megraud F, Lehours P. Helicobacter pyloriDetection and Antimicrobial Susceptibility Testing. Clin Microbiol Rev 2007; 20: 280–322.
Rak v Sloveniji 2009. Ljubljana: Onkološki inštitut Ljubljana, Epidemiologija in register raka, Register raka Republike Slovenije, 2013.
Graham DY, Shiotani A. New concepts of resistance in the treatment of Helicobacter pyloriinfections. Nat Clin Pract Gastroenterol Hepatol 2008; 5: 321–31.
Breuer T, Graham DY. Costs of diagnosis and treatment of Helicobacter pyloriinfection: when does choosing the treatment regimen based on susceptibility testing become cost effective? Am J Gastroenterology 1999; 94: 725–9.
Gerrits MM, Schuijffel D, van Zwet AA, Kuipers EJ, Vandenbroucke-Grauls CMJE, Kusters JG. Alterations in penicillin-binding protein 1A confer resistance to beta-lactam antibiotics in Helicobacter pylori. Antimicrob Agents Chemother 2002; 46: 2229–33.
Graham DY, Dore MP. Helicobacter pyloritherapy demystified. Helicobacter 2011; 16: 343–5.44 Zdrav Vestn | januar 2014 | Letnik 83 Izvirni članek/Original Article
Calvet X, Gisbert JP, Suarez D. Key points for designing and reporting Helicobacter pylori therapeutic trials: a personal view. Helicobacter 2011; 16: 346–55.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Infection with Helicobacter pylori. In: Schistosomes, Liver Flukes and Helicobacter pylori. Lyon; IARC Monographs 2009: 177–240.
Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N et al. Helicobacter pyloriinfection and the risk of gastric carcinoma. N Engl J Med 1991; 325: 1127–31.
Wang C, Yuan Y, Hunt RH. The association between Helicobacter pyloriinfection and early gastric cancer: a meta-analysis. Am J Gastroenterol 2007; 102: 1789–98.
Brenner H, Arndt V, Stegmaier C, Ziegler H, Rothenbacher D. Is Helicobacter pylori infection a necessary condition for noncardia gastric cancer? Am J Epidemiol 2004; 159: 252–8.
Talley NJ, Fock KM, Moayyedi P. Gastric cancer consensus conference recommends Helicobacter pyloriscreening and treatment in asymptomatic persons from high risk populations to prevent gastric cancer. Am J Gastroenterol 2008; 103: 510–4.
Mabe K, Ohno M, Ishigaki S, Suzuki M, Takahashi M, Ono S et al. Multi-center study of gastric cancers detected after Helicobacter pylorieradication. Abstract No. P5.09, Helicobacter 2012; 17 Suppl 1: 112.
Graham DY, Shiotani, A. New concepts of resistance in the treatment of Helicobacter pyloriinfections. Nat Clin Pract Gastroenterol Hepatol 2008; 5: 321–31.
Giorgio F, Principi M, de Francesco V, Zullo A, Losurdo G, Di Leo A, et al. Primary clarithromycin resistance to Helicobacter pylori: Is this the main reason for triple therapy failure? World J Gastrointest Pathophysiol 2013; 4: 43–6.
Zullo, A., Vaira, D., Vakil, N., Hassan, C., Gatta, L., Ricci, C., et al. High eradication rates of Helicobacter pyloriwith a new sequential treatment. Aliment Pharmacol Ther 2003; 17: 719–26.
Gatta L, Vakil N, Vaira D, Scarpignato C. Global eradication rates for Helicobacter pyloriinfection: systematic review and meta-analysis of sequential therapy. BMJ 2013; 347: 1–14.
McNicholl AG, Marin AC, Molina-Infante J, Castro M, Barrio J, Ducons J, et al. Randomised clinical trial comparing sequential and concomitant therapies for Helicobacter pylorieradication in routine clinical practice. Gut 2013; (published online first on May 11, doi: 10.1136/gutjnl-2013–304820).
Huang Y-K, Wu M-C, Wang SS, Kuo C-H, Lee Y-C, Chang L-L, et al. Lansoprazole-based sequential and concomitant therapy for the first-line Helicobacter pylorieradication. J Dig Dis 2012; 13: 232–8.
Georgopoulos S, Papastergiou V, Xirouchakis E, Laoudi F, Lisgos P, Spiliadi C, et al. Nonbismuth quadruple “concomitant” therapy versus standard triple therapy, both of the duration of 10 days, for first-line H. pylorieradication: a randomized trial. J Clin Gastroenterol 2013; 47: 228–32.
Cosme A, Montes M, Martos M, Gil I, Mendarte U, Salicio Y, et al. Usefulness of antimicrobial susceptibility in the eradication of Helicobacter pylori. Clin Microbiol Infect 2013; 19: 379–83.
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