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KMID : 0931320140140040249
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대한상부위장관.헬리코박터학회지
2014 Volume.14 No. 4 p.249 ~ p.254
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The Effect of Concomittent Therarpy and Quadruple Therapy for Patients Who Had23S Ribosomal Ribonucleic Acid Mutated Helicobacter pylori in Daegu andKyoungpook Area
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Jung Min-Kyu
Lee Jae-Kwang
Heo Jun
Kang Eun-Jeong
Lee Yu-Rim
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Abstract
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Background/Aims: Proton pump inhibitor (PPI) and two types of antimicrobial agents, amoxicillin, and clarithromycin have beenwidely used for the eradication of Helicobacter pylori. However, antibiotic resistant strains has rapidly increased and has emergedas an important factor for eraducation failure.
Materials and Methods: Patients diagnosed with chronic gastritis, peptic ulcer disease or gastric epithelial neoplasm was examinedby H. pylori PCR for mutation at 23S rRNA. Positive H. pylori PCR without 23S rRNA mutation was eradicated by standard tripletherapy. Patients with 23S rRNA mutation was eradicated by standard triple therapy or concomittent therapy with amoxicillin, PPI,clarithromycin and metronidazol or quadruple therapy with bismuth, PPI, tetracycline and metronidazol. We evaluated the predictorsof eradication failure with regards to 23S rRNA mutation and initial eradication regimen.
Results: Nine hundred sixty-one patients were studied. H. pylori PCR was positive in 35.0% of the patients and 23S rRNA mutatationwas found in 22.2% of the patients. The eradication rate of H. pylori for the A2143G point mutated group with standard tripletherapy was 28.5% and significantly lower than 93.1% of the wild type group and 100% of the concomitant therapy group, 66.6%of one week quadruple group and 100% of two week quadruple group (P＜0.005).
Conclusions: When 23S rRNA point mutation was positive, the standard triple therapy was not effective and the eradication rateswas only 22.2%. Alternative regimens should be considered when 23S rRNA point mutation is detected, especially when A2143Gpoint mutation is detected because A2143G point mutation is highly related to eradication failure.
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KEYWORD
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Helicobacter pylori, 23S rRNA, Clarithromycin, Resistance
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