Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Improved Eradication Rate of Standard Triple Therapy by Adding Bismuth and Probiotic Supplement for Helicobacter pylori Treatment in Thailand

  • Srinarong, Chanagune (Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital) ;
  • Siramolpiwat, Sith (Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital) ;
  • Wongcha-um, Arti (The University of Southampton) ;
  • Mahachai, Varocha (Gastrointestinal and Liver Center, Bangkok Medical Center) ;
  • Vilaichone, Ratha-Korn (Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital)
  • Published : 2014.12.18
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcer disease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However, standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy for H. pylori eradication. Materials and Methods: In this prospective single center study, H. pylori infected gastritis patients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo. Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycin MR once daily and 1,048mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt without probiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication was defined as a negative $^{13}C$-urea breath test at least 2 weeks after completion of treatment. Results: One hundred subjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%, 49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14 regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantly lower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%; p=0.04). Conclusions: The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent cure rate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19 genotype. Adding a probiotic also reduced treatment-related adverse events.

Keywords

References

  1. Abebaw W,Kibret M, Abera B (2014). Prevalence and risk factors of H. pylori from dyspeptic patients in northwest Ethiopia: a hospital based cross-sectional study. Asian Pac J Cancer Prev, 15, 4459-63. https://doi.org/10.7314/APJCP.2014.15.11.4459
  2. Armuzzi A, Cremonini F, Bartolozzi F, et al (2001). The effect of oral administration of Lactobacillus GG on antibioticassociated gastrointestinal side-effects during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther, 15, 163-9. https://doi.org/10.1046/j.1365-2036.2001.00923.x
  3. Armuzzi A, Cremonini F, Ojetti V, et al (2001). Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Digestion, 63, 1-7.
  4. Basiri Z, Safaralizadeh R, Bonyadi MJ, et al (2014). Helicobacter pylori vacA d1 genotype predicts risk of gastric adenocarcinoma and peptic ulcers in northwestern Iran. Asian Pac J Cancer Prev, 15, 1575-9. https://doi.org/10.7314/APJCP.2014.15.4.1575
  5. Chey WD, Wong BC (2007). American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol, 102, 1808-25. https://doi.org/10.1111/j.1572-0241.2007.01393.x
  6. de Martel C, Ferlay J, Franceschi S, et al (2012). Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol, 13, 607-15. https://doi.org/10.1016/S1470-2045(12)70137-7
  7. Demirel BB, Akkas BE, Vural GU (2013). Clinical factors related with Helicobacter pylori infection--is there an association with gastric cancer history in first-degree family members? Asian Pac J Cancer Prev, 14, 1797-802. https://doi.org/10.7314/APJCP.2013.14.3.1797
  8. Du YQ, Su T, Fan JG, et al (2012). Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection. World J Gastroenterol, 18, 6302-7. https://doi.org/10.3748/wjg.v18.i43.6302
  9. Fock KM (2014). Review article: the epidemiology and prevention of gastric cancer. Aliment Pharmacol Ther, 40, 250-60. https://doi.org/10.1111/apt.12814
  10. Fock KM, Katelaris P, Sugano K, et al (2009). Second Asia- Pacific Consensus Guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol, 24, 1587-1600. https://doi.org/10.1111/j.1440-1746.2009.05982.x
  11. Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P (2014). Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ, 348, 3174. https://doi.org/10.1136/bmj.g3174
  12. Ford AC, Malfertheiner P, Giguere M, et al (2008). Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol, 14, 7361-70. https://doi.org/10.3748/wjg.14.7361
  13. Fuller R (1991). Probiotics in human medicine. Gut, 32, 439-42. https://doi.org/10.1136/gut.32.4.439
  14. Graham DY (2009). Efficient identification and evaluation of effective Helicobacter pylori therapies. Clin Gastroenterol Hepatol, 7, 145-8. https://doi.org/10.1016/j.cgh.2008.10.024
  15. Graham DY, Lu H, Yamaoka Y (2007). A report card to grade Helicobacter pylori therapy. Helicobacter, 12, 275-8. https://doi.org/10.1111/j.1523-5378.2007.00518.x
  16. Hajmanoochehri F, Mohammadi N, Nasirian N, Hosseinkhani M (2013). Patho-epidemiological features of esophageal and gastric cancers in an endemic region: a 20-year retrospective study. Asian Pac J Cancer Prev, 14, 3491-7. https://doi.org/10.7314/APJCP.2013.14.6.3491
  17. IARC (1994) Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994. IARC Monogr Eval Carcinog Risks Hum, 61, 1-241.
  18. Karami N, Talebkhan Y, Saberi S, et al (2013). Seroreactivity to Helicobacter pylori antigens as a risk indicator of gastric cancer. Asian Pac J Cancer Prev, 14, 1813-7. https://doi.org/10.7314/APJCP.2013.14.3.1813
  19. Lin WL, Sun JL, Chang SC, et al (2014). Factors predicting survival of patients with gastric cancer. Asian Pac J Cancer Prev, 15, 5835-8. https://doi.org/10.7314/APJCP.2014.15.14.5835
  20. Mahachai V, Sirimontaporn N, Tumwasorn S, Thong-Ngam D, Vilaichone RK (2011). Sequential therapy in clarithromycinsensitive and -resistant Helicobacter pylori based on polymerase chain reaction molecular test. J Gastroenterol Hepatol, 26, 825-8. https://doi.org/10.1111/j.1440-1746.2011.06660.x
  21. Malfertheiner P, Megraud F, O'Morain CA, et al (2012). Management of helicobacter pylori infection--the maastricht iv/ florence consensus report. Gut, 61, 646-64. https://doi.org/10.1136/gutjnl-2012-302084
  22. Mirzaee V, Rezahosseini O (2012). Randomized control trial: comparison of triple therapy plus probiotic yogurt vs. standard triple therapy on Helicobacter pylori Eradication. Iran Red Crescent Med J, 14, 657-66.
  23. Otles S, Cagindi O, Akcicek E (2003). Probiotics and health. Asian Pac J Cancer Prev, 4, 369-72.
  24. Parsonnet J, Friedman GD, Vandersteen DP, et al (1991). Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med, 325, 1127-31. https://doi.org/10.1056/NEJM199110173251603
  25. Prasertpetmanee S, Mahachai V, Vilaichone RK (2013). Improved efficacy of proton pump inhibitor - amoxicillin - clarithromycin triple therapy for Helicobacter pylori eradication in low clarithromycin resistance areas or for tailored therapy. Helicobacter, 18, 270-3. https://doi.org/10.1111/hel.12041
  26. Rahman R, Asombang AW, Ibdah JA (2014). Characteristics of gastric cancer in Asia. World J Gastroenterol, 20, 4483-90. https://doi.org/10.3748/wjg.v20.i16.4483
  27. Rimbara E, Fischbach LA, Graham DY (2011). Optimal therapy for Helicobacter pylori infections. Nat Rev Gastroenterol Hepatol, 8, 79-88. https://doi.org/10.1038/nrgastro.2010.210
  28. Sheu BS, Cheng HC, Kao AW, et al (2006). Pretreatment with Lactobacillus- and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy. Am J Clin Nutr, 83, 864-9.
  29. Uemura N, Okamoto S, Yamamoto S, et al (2001). Helicobacter pylori infection and the development of gastric cancer. N Engl J Med, 345, 784-9. https://doi.org/10.1056/NEJMoa001999
  30. Vilaichone RK, Mahachai V (2001). Current management of Helicobacter pylori infection. J Med Assoc Thai, 84, 32-38.
  31. Vilaichone RK, Mahachai V, Graham DY (2006). Helicobacter pylori diagnosis and management. Gastroenterol Clin North Am, 35, 229-47. https://doi.org/10.1016/j.gtc.2006.03.004
  32. Wang YH, Huang Y (2014). Effect of Lactobacillus acidophilus and Bifidobacterium bifidum supplementation to standard triple therapy on Helicobacter pylori eradication and dynamic changes in intestinal flora. World J Microbiol Biotechnol, 30, 847-853. https://doi.org/10.1007/s11274-013-1490-2
  33. Zheng X, Lyu L, Mei Z (2013). Lactobacillus-containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis. Rev Esp Enferm Dig, 105, 445-53. https://doi.org/10.4321/S1130-01082013000800002

Cited by

  1. Effects of the CYP2C19 Genetic Polymorphism on Gastritis, Peptic Ulcer Disease, Peptic Ulcer Bleeding and Gastric Cancer vol.15, pp.24, 2014, https://doi.org/10.7314/APJCP.2014.15.24.10957
  2. High Efficacy of Levofloxacin-Dexlansoprazole-Based Quadruple Therapy as a First Line Treatment for Helicobacter pylori Eradication in Thailand vol.16, pp.10, 2015, https://doi.org/10.7314/APJCP.2015.16.10.4353
  3. Effect of Pretreatment with Lactobacillus delbrueckii and Streptococcus thermophillus on Tailored Triple Therapy for Helicobacter pylori Eradication: A Prospective Randomized Controlled Clinical Trial vol.16, pp.12, 2015, https://doi.org/10.7314/APJCP.2015.16.12.4885
  4. Seven-Day Bismuth-based Quadruple Therapy as an Initial Treatment for Helicobacter pylori Infection in a High Metronidazole Resistant Area vol.16, pp.14, 2015, https://doi.org/10.7314/APJCP.2015.16.14.6089
  5. CYP2C19 Genotype Could be a Predictive Factor for Aggressive Manifestations of Hepatocellular Carcinoma Related with Chronic Hepatitis B Infection in Thailand vol.16, pp.8, 2015, https://doi.org/10.7314/APJCP.2015.16.8.3253
  6. Growth inhibition and IRT1 induction of Arabidopsis thaliana in response to bismuth vol.58, pp.5, 2015, https://doi.org/10.1007/s12374-015-0256-9
  7. Antibiotic Resistant Pattern of Helicobacter Pylori Infection Based on Molecular Tests in Laos vol.17, pp.1, 2016, https://doi.org/10.7314/APJCP.2016.17.1.285
  8. Effect of IL-1 Polymorphisms, CYP2C19 Genotype and Antibiotic Resistance on Helicobacter pylori Eradication Comparing Between 10-day Sequential Therapy and 14-day Standard Triple Therapy with Four-Times-Daily-Dosing of Amoxicillin in Thailand: a Prospective Randomized Study vol.17, pp.4, 2016, https://doi.org/10.7314/APJCP.2016.17.4.1903
  9. eradication with triple therapy vol.65, pp.5, 2016, https://doi.org/10.1136/gutjnl-2015-311019
  10. infection—the Maastricht V/Florence Consensus Report vol.66, pp.1, 2016, https://doi.org/10.1136/gutjnl-2016-312288
  11. in pathogenesis and prevention efforts vol.92, pp.1090, 2016, https://doi.org/10.1136/postgradmedj-2016-133997
  12. Extremely High Prevalence of Metronidazole-Resistant Helicobacter pylori Strains in Mountain People (Karen and Hmong) in Thailand vol.94, pp.4, 2016, https://doi.org/10.4269/ajtmh.15-0449
  13. eradication therapy vol.18, pp.4, 2017, https://doi.org/10.1111/1751-2980.12466
  14. vol.2017, pp.1687-630X, 2017, https://doi.org/10.1155/2017/5320180
  15. eradication therapies vol.22, pp.4, 2017, https://doi.org/10.1111/hel.12392
  16. infection and associated side effects vol.7, pp.4, 2016, https://doi.org/10.3920/BM2015.0130
  17. Probiotics in Gastroenterology: How Pro Is the Evidence in Adults? vol.113, pp.8, 2018, https://doi.org/10.1038/s41395-018-0138-0
  18. infection vol.23, pp.2, 2018, https://doi.org/10.1111/hel.12475
  19. Infection vol.12, pp.2, 2018, https://doi.org/10.5009/gnl17177