DOES PRETREATMENT WITH OMEPRAZOLE DECREASE THE CHANCE OF ERADICATION OF HELICOBACTER-PYLORI IN PEPTIC-ULCER PATIENTS

Objective: It has been reported that pretreatment with omeprazole coul d decrease the efficacy of Helicobacter pylori eradication. Our aim wa s to compare the efficacy, safety, and tolerability of the eradicating regimen, omeprazole/amoxicillin/metronidazole. The two antibiotics we re scheduled either during the first or during the last 2 wk of omepra zole administration. Methods: In this prospective controlled study con ducted in a single center, 78 symptomatic peptic ulcer patients were t reated for 4 wk with omeprazole 40 mg o.m.; the patients were randomly assigned to receive amoxicillin 1 g t.i.d postprandially and metronid azole 250 mg t.i.d. postprandially, either during the first 2 wk (grou p A, n = 40) or the last 2 wk of therapy with omeprazole (group B, n = 38). N. pylori status was assessed by culture, histology, urease test , and IgG antibodies. Each patient's course was followed for 1 yr. Res ults: N. pylori infection was cured in 97.4% of group A (95% CI: 0.84- 0.99) and in 89% of group B (95% CI: 0.73-0.96, p = 0.28). Healing was achieved in 80% of the patients in group A (95% CI: 0.63-0.90) and in 75.7% of patients in group B (95% CH: 0.60-0.90, p = 0.60) At 12-mont h follow-up, 72 patients were evaluated: 37/38 (97%) of patients in gr oup A and 33/33 (100%) in group R were confirmed as cured of the infec tion (NS), Peptic ulcer healing rate reached 100% ire the two groups. Furthermore, between the two groups, there were tao significant differ ences in symptom relief or improvement. Both regimens were well tolera ted, and no patient had to be withdrawn from therapy because of an adv erse event. Minor side-effects appeared to be similar in the two group s (40% vs. 38%). Conclusions: This randomized study clearly indicates that omeprazole pretreatment does not significantly reduce the efficac y of eradicating therapy for N. pylori in peptic ulcer patients.