AGE-DEPENDENT ERADICATION OF HELICOBACTER-PYLORI WITH DUAL THERAPY

Background: Combined treatment using an acid-inhibiting drug with anti biotics can cure Helicobacter pylori infection. However, eradication r ates are highly variable, especially if a proton pump inhibitor is use d with amoxycillin. Therefore it is important to define factors/predic tors of the clinical outcome. Methods: In a single-blind study, 60 H. pylori-positive patients prospectively matched for diagnosis (erosive gastritis, duodenal and gastric ulcer), age (above and below 50 years) and smoking habits were randomly treated (each group n = 20) for 2 we eks with amoxycillin (1 mg b.d.) and either omeprazole (20 mg b.d.), l ansoprazole (30 mg b.d.) or ranitidine (300 mg b.d.). Intragastric pH and plasma levels of the administered drugs were monitored over a dosi ng interval of 12 h. Results: The overall eradication rates were 45% ( intention-to-treat, ITT, 27/60) or 47% (per protocol 27/58); they did not differ (ITT) between omeprazole (50%), lansoprazole (40%) and rani tidine (45%). Median pH and time at which intragastric pH was above 4 was slightly lower for ranitidine (4.0 +/- 1.7; 51 +/- 25%) than for o meprazole (5.4 +/- 1.1; 77 +/- 25%; P < 0.05) or lansoprazole (4.4 +/- 1.6; 68 +/- 32%). Plasma concentrations of amoxycillin were comparabl e in all three treatment groups. Post-treatment H. pylori status was n ot dependent on those levels, or the drug-induced extent or duration o f increased intragastric pH. However, H. pylori-eradicated patients we re significantly (P < 0.05) older (56 +/- 13 years) than patients stil l H. pylori-positive (47 +/- 14 years). In addition, in patients older than 50 years (n = 33), eradication was higher (P < 0.01) than in pat ients (n = 25) below 50 years (65 vs. 24%). Eradication rate was highe st (75-83%) in subgroups of patients (>50 years and history of peptic ulcer or smokers). Neither activity/grade of peptic ulcer or erosive g astritis nor initial diagnosis were predictors for clinical outcome. C onclusion: The age of patients must be regarded as a major determinant of H. pylori eradication rate and may represent an important factor c ontributing to the highly variable clinical results.