What is the best strategy for treating Helicobacter pylori?

The most popular treatment for H pylori is triple therapy but resistance to Clarithromycin is reducing its effectiveness. Courses using four drugs have been known to be more successful but are used less popular because of their side-effects. While, what is the best way for treating H pylori-related diseases.

A research article to be published on 28 June 2008, in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Mr Siok Ching from United Kingdom compared a lansoprazole-based triple versus quadruple therapy for H pylori eradication with emphasis on side effect profile, patient compliance and eradication rate at a rural district general hospital in Wales, United Kingdom.

Overall the treatment of H Pylori using both three drugs and four drugs are still highly effective in rural North Wales (92%), however, almost all (97%) of the patients who managed to complete the course of four tablets got rid of the infection.

Authors feel that treatments with four drugs remain the best option for white Caucasians in rural UK. Patients need educating about the side effects of the drugs and the reasons for treatment so that they can reap the full benefits.

They concluded that one-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy, which can compromise patient compliance. Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen.

The side effects may be reduced by replacing metronidazole with amoxycillin but patients should be better educated about the side effects in order to improve compliance and cure rates.

Reference: Ching SS, Sabanathan S, Jenkinson LR. Treatment of H pylori in surgical practice: A randomised trial of triple versus quadruple therapy in a rural district general hospital. World J Gastroenterol 2008; 14(24): 3855-3860
http://www.wjgnet.com/1007-9327/14/3855.asp

Correspondence to: Lloyd R. Jenkinson, Department of Surgery, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, Wales, United Kingdom. lloydjenk@btinternet.com
Telephone: +44-124-8384308 Fax: +44-124-8384675

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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