What is the impact of Helicobacter pylori density on the success of eradication therapy: A clinico-histopathological study

摘要

Background and objective: To investigate the presence of any possible association between H.pylori density in the stomach and the efficacy of triple (lansoprazole 30. mg b.i.d., clarithromycin 500. mg b.i.d. and amoxicillin 1. g b.i.d. for 14 days) and bismuth-containing quadruple (colloidal bismuth subcitrate 300. mg q.i.d., lansoprazole 30. mg b.i.d., tetracycline 500. mg q.i.d. and metronidazole 500. mg t.i.d. for 14 days) eradication therapies. Methods: Eighty-five cases with H.pylori infection (proved by rapid urease test and histology) were studied. In each case, the density of H.pylori colonization was graded according to the updated Sydney classification. H.pylori eradication was determined via the 14C-Urea breath test performed 4weeks after the end of therapy. Results: The eradication rate of H.pylori was 50% (30 out of 60) in the triple therapy and 92% (23 of 25) in the quadruple therapy group. In the triple therapy group, the eradication rate of H.pylori decreased as the initial density of H.. pylori increased (density of H.. pylori: 1, 58.3%; 2, 54.5%; 3, 52.4%; 4, 38.5%; 5, 33.3%). In two cases with eradication failure after quadruple therapy, the grades of bacterial density were 1 and 3. Conclusion: H.pylori density, as assessed by histological grading, may predict the usefulness of triple therapy. The higher the H.pylori density, the less effective triple therapy will be at successful eradication of H.pylori. Quadruple therapy does not seem to be negatively affected by bacterial density.