The impact of bismuth addition to sequential treatment on Helicobacter pylori eradication: A pilot study

• Published in: Bosnian journal of basic medical sciences Vol. 15; no. 4; pp. 50 - 54
• Main Authors: Basyigit, Sebahat, Kefeli, Ayse, Sapmaz, Ferdane, Yeniova, Abdullah Ozgür, Asilturk, Zeliha, Hokkaomeroglu, Murat, Uzman, Metin, Nazligul, Yasar
• Format: Journal Article
• Language: English
• Published: Bosnia and Herzegovina Association of Basic Medical Sciences 25-10-2015; Association of Basic Medical Sciences of Federation of Bosnia and Herzegovina
• Subjects: Adult; Amoxicillin; Amoxicillin - adverse effects; Amoxicillin - therapeutic use; Antacids - adverse effects; Antacids - therapeutic use; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antiprotozoan agents; Antiulcer agents; Bismuth - adverse effects; Bismuth - therapeutic use; Breath Tests; Clarithromycin - therapeutic use; Drug Resistance, Bacterial; Female; Gastric Mucosa - pathology; Health aspects; Helicobacter infections; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - drug effects; Humans; Male; Medical research; Metronidazole - therapeutic use; Microbial drug resistance; Middle Aged; Pilot Projects; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Therapeutics; Treatment Outcome; Urea
• ISSN: 1512-8601; 1840-4812
• DOI: 10.17305/bjbms.2015.573

The success of the current anti-Helicobacter pylori (H. pylori) treatment protocols is reported to decrease by years, and research is needed to strengthen the H. pylori eradication treatment. Sequential treatment (ST), one of the treatment modalities for H. pylori eradication, includes amoxicillin 1 gr b.i.d and proton pump inhibitor b.i.d for first 5 days and then includes clarithromycin 500 mg b.i.d, metronidazole 500 mg b.i.d and a proton pump inhibitor b.i.d for remaining 5 days. In this study, we investigated efficacy and tolerability of bismuth addition in to ST. We included patients that underwent upper gastrointestinal endoscopy in which H. pylori infection was diagnosed by histological examination of antral and corporal gastric mucosa biopsy. Participants were randomly administered ST or bismuth containing ST (BST) protocols for the first-line H. pylori eradication therapy. Participants have been tested by urea breath test for eradication success 6 weeks after the completion of treatment. One hundred and fifty patients (93 female, 57 male) were enrolled. There were no significant differences in eradication rates for both intention to treat population (70.2%, 95% confidence interval [CI]: 66.3-74.1% vs. 71.8%, 95% CI: 61.8-81.7%, for ST and BST, respectively, p>0.05) and per protocol population (74.6%, 95% CI: 63.2-85.8% vs. 73.7%, 95% CI: 63.9-83.5% for ST and BST, respectively, p>0.05). Despite the undeniable effect of bismuth, there may be several possible reasons of unsatisfactory eradication success. Drug administration time, coadministration of other drugs, possible H. pylori resistance to bismuth may affect the eradication success. The addition of bismuth subcitrate to ST regimen does not provide significant increase in eradication rates.