Tailored eradication vs empirical bismuth-containing quadruple therapy for first-line Helicobacter pylori eradication: A comparative,open trial

摘要

BACKGROUND Few studies have compared the efficacy and safety profile of a tailored eradication(TR)strategy based on the presence of a 23S ribosomal RNA point mutation with those of empirical bismuth-based quadruple therapy(EBQT)for first-line eradication of Helicobacter pylori(H.pylori)in Korean patients.AIM To compare the efficacy and safety of a TR strategy and those of EBQT regimen as first-line eradication therapy for H.pylori.METHODS This is an open-label,comparative study in which we prospectively enrolled patients over 18 years of age with H.pylori infection and retrospectively reviewed their data.H.pylori-positive patients diagnosed by rapid urease test,Giemsa staining,or dual priming oligonucleotide polymerase chain reaction(DPO-PCR)were enrolled from May 2016 to September 2018 at Gil Medical Center.Patients with H.pylori infection received either a TR regimen or the EBQT regimen.In the tailored therapy group that underwent DPO-PCR testing,patients with A2142G and/or A2143G point mutations were treated with a bismuth-containing quadruple regimen.The eradication rate,patient-reported side effect rate,and H.pylori eradication success rate were evaluated and compared between the groups.RESULTS A total of 150 patients were assigned to the TR(n=50)or EBQT group(n=100).The first-line eradication rate of H.pylori did not differ between the groups(96.0%vs 95.7%,P=0.9).The rate of eradication-related side effects for TR was 12.0%,which differed significantly from that of EBQT(43.0%)for first-line treatment(P<0.001).CONCLUSION DPO-PCR-based TR for H.pylori eradication may be equally efficacious,with less treatment-related complications,compared to EBQT in Korea,where clarithromycin resistance is high.