Triple and Quadruple Eradication Therapy for H. pylori in Iraqi Patients with Peptic Ulcer Disease a Comparative Study

Abstract

The eradication of H. pylori has become an important issue; since Helicobacter pylori infection can cause chronic gastritis, peptic ulcer, gastric cancer and (MALT) lymphoma. Standard triple therapy efficacy has decreased gradually worldwide during the last decade and quadruple therapy is recommended as an alternate treatment option for the management of H. pylori. The aim of this study was to compare between triple and quadruple therapy for eradication of H. pylori in Iraqi patients with peptic ulcer disease, and to treat the patients who relapsed after triple therapy. In addition to that; response to therapy (triple and quadruple) have been evaluated according to the Body Mass Index (BMI). A prospective case controlled study was carried on 60 patients who had peptic ulcer disease and positive H. pylori infection confirmed by (histology; stool antigen test and anti-H. pylori IgG antibody test) patients were divided into 3 groups first group involved 38 patients treated with triple therapy (500 mg clarithromycin capsules; 1 g amoxicillin capsules; and 20 mg esomeprazole capsules) for 14 days. The second group involved 22 patients treated with quadruple therapy (pylera)®; (140 mg bismuth sub citrate potassium, 125 mg metronidazole, and 125 mg tetracycline hydrochloride) for 10 days, while third group involved patients un responding to triple therapy treated with second- line quadruple therapy for 10 days. The results showed that the eradication rate of the per-protocol and intention-to-treat for quadruple therapy was 88.57%, 83.78% respectively which was more than 57.89% per-protocol and 50% intention-to-treat for standard triple therapy with high significant difference (p<0.01). Patients compliance with quadruple and triple therapy was good for the two regimens in spite of the more adverse effect of quadruple regimen compared to triple regimen. On conclusion; the 10 days treatment with quadruple therapy was more effective than 14 days triple therapy that could be attributed to more eradication rate for H. pylori.