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KMID : 0931320230230020125
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대한상부위장관.헬리코박터학회지
2023 Volume.23 No. 2 p.125 ~ p.131
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Eradication of Helicobacter pylori Infection Using 7-day PCR-based Tailored Therapy
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Kim Young-Woo
Kang Hee-Jun
Moon Sang-Gon
Kim Bo-Hyoung
Lee Hye-Yeon
Lim Chul-Hyun
Oh Jung-Hwan
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Abstract
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Background/Aims: Standard triple therapy (STT; proton pump inhibitor [PPI]+clarithromycin+amoxicillin) used for Helicobacter pylori (H. pylori) eradication has shown low treatment success rates in recent years, which is most likely attributable to increased clarithromycin resistance. In this study, we compared treatment success rates of tailored therapy (TT) using real-time polymerase chain reaction (RT-PCR) and empirical STT.
Methods: This retrospective study included 650 patients with H. pylori infection, who visited Eunpyeong St. Mary’s Hospital in Korea; 343 patients received TT based on RT-PCR assays, and 307 patients received STT. Eradication success was defined as a negative 13C-urea breath test result 4~8 weeks after treatment completion. Patients who failed first-line therapy and those with clarithromycin resistance received bismuth-containing quadruple therapy (BQT; PPI+bismuth+metronidazole+tetracycline).
Results: Intention-to-treat analysis showed that H. pylori eradication rates were higher in patients who received RT-PCR?based TT than in those who were treated using empirical STT (80.5% [190/236] vs. 70.4% [216/307], P=0.069). Per-protocol (PP) analysis showed similar results (84.4% [190/225] vs. 74.7% [216/289], P=0.007). PP analysis showed that 7-day TT treatment was associated with a higher eradication rate than that observed with 10- to 14-day STT (85.2% [178/209] vs. 73.8% [59/80], P=0.029). The clarithromycin resistance rate was 27.9% (87/312). The eradication success rate was 89.2% (74/83) in patients with clarithromycin resistance, who received BQT as first-line therapy
Conclusions: The treatment success rate was higher in patients who received 7-day RT-PCR?based TT than in those who were administered 10- to 14-day empirical treatment.
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KEYWORD
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Clarithromycin, Helicobacter pylori, Polymerase chain reaction
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