Relation between alcohol consumption and the success of Helicobacter pylori eradication therapy using omeprazole, clarithromycin and amoxicillin for 1 week.

OBJECTIVE: To study the relationship between daily alcohol consumption and the result of eradication therapy for Helicobacter pylori using omeprazole, clarithromycin and amoxicillin for 1 week. DESIGN: Clinical trial. SETTING: Urban health centre, general medicine section. PARTICIPANTS: One hundred and fifty-six patients with a diagnosis of peptic ulcus or chronic gastritis. Helicobacter pylori infection was confirmed by the urease test, the 14C-urea breath test, IgG serology or biopsy. INTERVENTIONS: A combination of omeprazole, 20 mg twice daily, clarithromycin, 500 mg twice daily, and amoxicillin, 1000 mg twice daily was administered for 1 week. No other drugs were given. Four to 8 weeks later a 14C-urea breath test was carried out to confirm eradication. MAIN OUTCOME MEASURES: Logistic regression was used to assess the relationship between eradication and daily alcohol consumption (main covariable), age, sex, smoking, length of illness, pathology studied (ulcus or gastritis) and therapeutic compliance. RESULTS: Eradication (intention to treat analysis) was successful in 118 patients (75.6%; 95% CI, 68.9-82.4). The only variable significantly associated with the result of the therapy was daily alcohol consumption, with a higher probability of failure in non-consumers (29.9%) than in consumers (12.2%), adjusted OR 3.24 (95% CI, 1.12-9.20; P = 0.03). Eradication was dose dependent: 70.1% in abstemious patients (n = 107), rising to 79.3% in users of 4-16 g of pure ethanol a day (n = 29) and to 100% in users of 18-60 g daily (n = 20) with a P value of 0.005 for the trend. CONCLUSIONS: Daily alcohol consumption appears to have an additive effect in this eradication therapy.

Erradicación de Helicobacter pylori: anotaciones desde el consenso / Helicobacter pylori erradication: comments from the consensus

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Eficacia de una terapia secuencial en la erradicación de Helicobacter pylori: cuádruple terapia con omeprazol, metronidazol, tetraciclina y bismuto tras el fracaso de la combinación de omeprazol, claritromicina y amoxicilina / Efficacy of a multistep strategy for Helicobacter pylori eradication: quadruple therapy with omeprazole, metronidazole, tetracycline and bismuth after failure of combination of omeprazole, clarithromycin and amoxycillin

Fundamento: Evaluar la eficacia de una terapia secuencial para erradicar a Helicobacter pylori (HP). Pacientes y método: Un total de 151 pacientes, con ulcus péptico o gastritis crónica, infectados por HP, tratados (primera etapa) con una combinación de omeprazol (20 mg/12 h), claritromicina (500 mg/12 h) y amoxicilina (1 g/12 h) (OCA) durante una semana y posteriormente (segunda etapa, si fracasaba la erradicación) con una combinación de omeprazol (20 mg/12 h), metronidazol (500 mg/12 h), tetraciclina (500 mg/6 h) y bismuto (120 mg/6 h) (OMTB) durante 14 días. Resultados: Por intención de tratar se erradicó con OCA en el 78,1 por ciento (IC del 95 por ciento: 71,6-84,7) y con OMTB en el 90,3 por ciento (IC del 95 por ciento: 74,2-98), siendo la proporción acumulada del 96,7 por ciento (IC del 95 por ciento: 92,4-98,9). Conclusiones: La eficacia de la estrategia estudiada es elevada. La combinación OMTB es una buena opción tras el fracaso de la OCA. (AU)