SUCRALFATE AS AN ALTERNATIVE TO BISMUTH IN QUADRUPLE THERAPY FOR HELICOBACTER-PYLORI ERADICATION

Background. There are persuasive arguments for treating all patients w ith Helicobacter pylori-associated peptic ulcer disease. However, the choice of therapeutic regimen remains problematical. Bismuth triple th erapy produces greater than 80% cure of H. pylori infection, whereas o meprazole and bismuth quadruple therapy has produced cure rates in exc ess of 90%. Colloidal bismuth is not available in many countries, henc e limiting the use of bismuth-based therapeutic regimens. We substitut ed widely available sucralfate for bismuth in a quadruple-therapy regi men. Method. We studied 223 consecutive patients with gastritis or pep tic ulcer disease in whom H. pylori infection was confirmed by CLOtest (Delta West Ltd., Bentley, WA, Australia) or histological assessment. Successful therapy was validated by the C-14 urea breath test 4 to 6 weeks after therapy. Omeprazole, 20 mg was given twice daily for 10 da ys. After 3 days of omeprazole sucralfate (1 gm qid), tetracycline (50 0 mg qid) and metronidazole (400 mg tid) were added for 7 days. Result s. Therapy was successful in 194 of 223 patients (87%). Compliance was excellent, with only two patients being unable to tolerate therapy. S ide effects were minimal and included nausea, vomiting, headache, and vaginal moniliasis. At 6 months' follow-up, 10 of 210 patients (5%) wh o were previously documented as ''cured'' had a positive breath test. Conclusions. The wide availability of sucralfate in many countries mak es it a possible alternative to bismuth for use in proton pump quadrup le-therapy regimens, achieving a reasonable cure rate for H. pylori in fection.