Standard First-line Triple Therapy for Helicobacter pylori Infection: A Comparison of Eradication Rates Based on Timing of Administration of Proton Pump Inhibitors

ABSTRACT

BACKGROUND/AIMS: Recent Korean studies performed over the past few decades have shown diminishing efficacy and unacceptability of clarithromycin-based triple therapy as first-line eradication therapy for Helicobacter pylori infection, based on evidence of a declining eradication rate. Triple therapy continues to be used as first-line eradication therapy despite concerns regarding high clarithromycin resistance among Koreans. Patient compliance and acid suppression are important factors associated with the H. pylori eradication rate. We investigated whether regular administration of a proton pump inhibitor (PPI) 30 minutes before a meal can improve the eradication rate. MATERIALS AND METHODS: We retrospectively analyzed the data of 316 patients who were treated with first-line triple therapy (PPI, amoxicillin, and clarithromycin) for H. pylori infection between January 2012 and September 2017. Patients were divided into 2 groups based on the time of administration of the PPI (group A before a meal, group B after a meal). The urea breath test was performed 4~6 weeks after eradication of infection. RESULTS: Notably, 249 patients (78.8%, 249/316) showed successful eradication. The eradication rates in groups A and B were 87.5% (49/56 patients) and 76.9% (200/260 patients), respectively. We observed that regular administration of PPI before meals improved the eradication rate (P=0.079). CONCLUSIONS: We observed that although clarithromycin-based triple therapy was associated with an overall eradication rate <80%, regular PPI administration before meals improved the eradication rate. Regular PPI administration before meals and effective education to improve patient compliance could improve the eradication rate through maximal acid suppression.