Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5247
Peer-review started: April 29, 2021
First decision: June 3, 2021
Revised: July 9, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: August 21, 2021
Antibiotic resistance to Helicobacter pylori (H. pylori) infection has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for H. pylori infection has got attention.
However, there is limited data regarding efficacy of TT strategy in treatment of H. pylori infection in Korea as compared to that of concomitant therapy (CT) regimen.
To investigate the efficacy and safety profiles of TT for H. pylori infection treatment compared to a non-bismuth quadruple therapy, CT.
We included treatment naive H. pylori infection patients (> 18 years) who visited the Gil Medical Center between March 2016 and October 2020. After randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were compared between the two groups. For the TT group, a dual priming oligonucleotide polymerase chain reaction (DPO-PCR) test, which detected A2142G and/or A2143G point mutations, and a clarithromycin (CLR) resistance test were performed. Patients in the CLR-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen.
Of the 217 patients with a treatment naive H. pylori infection, 110 patients [mean age: 58.66 ± 13.03, men, n = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, n = 52 (48.60%)] were treated with CT. The compliance (TT vs CT, 100% vs 98.13%, P = 0.30), and follow-up loss rates (8.18% vs 9.35%, P = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT vs CT, 82.73% vs 82.24%, P = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% vs 50.52%, P < 0.001).
The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistance rates.
The DPO-based TT regimen might role as a first-line Helicobacter eradication regimen with similar efficacy and safety profiles as compared to CT regimen.