AUGMENTED ERADICATION RATES OF HELICOBACTER-PYLORI BY NEW COMBINATIONTHERAPY WITH LANSOPRAZOLE, AMOXICILLIN, AND REBAMIPIDE

The aim of the present study was to determine the efficacy of a new co mbination regimen including an antioxidant, a proton pump inhibitor, a nd antibiotics against Helicobacter pylori and to document the changes of oxidative stress and cytokines involved in H. pylori-associated ga stric inflammation. From 57 patients with endoscopically diagnosed gas tric and/or duodenal ulcers associated with H. pylori infection five g astric antral biopsy specimens were taken for the diagnosis of H. pylo ri and for the experimental measures. The patients were then treated e ither with lansoprazole 30 mg + amoxicillin 1.5 g (LA group; 21 patien ts) or lansoprazole 30 mg + amoxicillin 1.5 g + rebamipide 300 mg (LAM group; 36 patients) for two weeks, Four weeks after the initiation of treatment, the patients were endoscoped again and biopsy specimens we re obtained. Mucosal malondialdehyde (MDA) levels; myeloperoxidase (MP O) activities; superoxide dismutase; catalase; glutathione peroxidase; cytokines IL-1, IL-6, TNF-alpha; and chemokines IL-8, GRO-alpha, RANT ES (regulated on activation normal T expressed and secreted) were meas ured, Using paraffin-embedded tissue sections, in situ terminal deoxyr ibonucleotide transferase (TdT) mediated dUTP nick end labeling (TUNEL ) for apoptosis and immunohistochemical staining for inducible nitric oxide synthase (iNOS) were performed. Two weeks of treatment with the LA regimen resulted in 57.4% eradication rates of H. pylori, whereas t wo weeks of treatment with the LAM regimen resulted in 75.0% eradicati on rates, Eradication rates between these two groups were statisticall y significantly different (P < 0.05). Mucosal MDA levels and MPO activ ities were significantly lower in the LAM group than the LA group. Muc osal levels of cytokines IL-1, IL-6, and TNF-alpha and of chemokines I L-8, GRO-alpha, and RANTES were all significantly decreased after the treatment of H. pylori, especially so in the LAM group. The apoptotic index and iNOS score were significantly reduced after the eradication of H. pylori. The addition of an antioxidative drug to the eradication regimen against H. pylori has advantages either in augmenting the era dication rates of H. pylori or in decreasing the oxidative stress and cytokines levels generated by H. pylori infection.