Do some patients with Helicobacter pylori infection benefit from an extension to 2 weeks of a proton pump inhibitor-based triple eradication therapy?

OBJECTIVES: Seven-day proton pump inhibitor (PPI)-based triple therapies ar e the first-line anti-Helicobacter pylori regimens; to date, however, there is still no agreement concerning all the predictors of H. pylori cure unde r these regimens. The aim of this prospective study was to evaluate whether patients with certain pretreatment characteristics may benefit from an ext ension from 1 to 2 wk of treatment with lansoprazole, amoxycillin, and clar ithromycin. METHODS: A total of 142 patients with H. pylori infection ascertained by me ans of gastric histopathology and C-13 urea breath test (UBT) participated in this study. In all patients H. pylori density was determined at histolog y both on antral and corpus biopsies, and H. pylori culture with antibiotic susceptibility testing; Ige anti-H. pylori titers were also determined bef ore therapy. Patients were randomized to receive 1-wk versus 2-wk of treatm ent with lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d), and am oxycillin (1 g b.i.d.). The association between eradication and potential p redictors was analyzed by means of unconditional logistic regression models and stratified according to the duration of treatment. A stepwise regressi on analysis was performed to identify variables discriminated between subje cts, using eradication status as the dependent variable. RESULTS: The overall eradication rates for 1- and 2-wk treatments were 74.6 % and 85.9% (intention-to-treat analysis) and 81.5% and 89.1% (per-protocol analysis), respectively (p = NS). Multivariate discriminant analysis selec ted as the variables independently related to eradication cigarette smoking (OR = 3.98), delta of C-13-UBT higher than 35 (OR = 9.21) and IgG anti-H. pylori titer greater than or equal to 93 (OR = 0.24) for the whole series o f subjects. Stratified analysis according to the duration of therapy select ed H. pylori density as the only predictor of eradication in the group trea ted for 1 wk (OR = 8.11). In contrast, no significant predictors were found in the group treated for 2 wk. CONCLUSIONS: Patients with a high intragastric bacterial load, as detected by histology (grade 3) or C-13-UBT (delta = 35) may benefit from an extensi on to 2 wk of triple therapy with lansoprazole. amoxycillin, and clarithrom ycin.