Helicobacter pylori eradication with dual and low-dose triple therapy in patients with liver cirrhosis

Background and Aims, Few data exist on the treatment of Helicobacter pylori infection in cirrhotic patients. In this study we assessed the efficacy of standard dual and one-week low-dose triple therapy on Helicobacter pylori eradication in cirrhotics. Patients and Methods. In a prospective study, 83 cirrhotic patients with ep igastric pain were randomised to receive either a two-week course of dual t herapy, composed of omeprazole 20 mg b.d. plus amoxycillin 1 g b.d. (n=41) or a one-week course of triple therapy composed of omeprazole 20 mg b.d., c larithromycin 250 mg b.d., and tetracycline 500 mg b.d (n=42). Helicobacter pylori infection at entry and eradication 6-8 week after the end of therap y were assessed by rapid urease test and histology on biopsies from the ant rum and corpus. When eradication did not occur with either dual or triple t herapy patients were given the alternative regimen. Helicobacter pylori era dication in these patients was assessed 6-8 weeks after the end of treatmen t by a further endoscopy. Results Helicobacter pylori eradication was achieved in 87.8% (36 out of 41 ; 95% confidence interval 77.8-97.8%) of patients after dual therapy and in 85.7% (36 out of 42; 95% confidence interval 75.1-96.3%) of patients treat ed with triple therapy (p=NS). In patients in whom initial eradication was unsuccessful, re-treatment eradicated Helicobacter pylori in 4 out of 5 pat ients given the triple regimen and in all 5 patients who received the dual therapy One patient was lost to follow-up. No major side-effects were repor ted for either treatment regimen. Conclusions, Our data show that both dual and triple therapies are effectiv e in Helicobacter pylori eradication in cirrhotics as well as in eradicatio n failure patients. Therefore, the use of the dual therapy regimen is stron gly suggested as an initial treatment for Helicobacter pylori eradication i n cirrhotic patients.