Prospective Randomized Trial of Esomeprazole versus Lansoprazole and Omeprazole Based Triple Therapy for H. Pylori Eradication in an Iranian Population

摘要

Background:Althoughtripletherapywithoneprotonpumpinhibitor(PPI)andtwoantibioticsforoneweekhasbeenintroducedasthetreatmentofchoice,quadrupletherapyinIranisthestandardtreatmentduetotheorganisma€?shighresistanceisrelatedtoHelicobacterpylori(H.pylori)organism.Objective:ComparisonofthreedifferentPPIs;esomeprazole,lansoprazoleandomeprazolewithalongerduration(10days)foreradicationofH.pyloriintheIranianpopulation.MaterialsandMethods:Two-hundredninety-fourpatientswithendoscopicevidenceofpepticulcer,non-ulcerdyspepsia,gastritisoracidrefluxandconfirmedH.pylori,eitherbyhistologyorapositiveureatestwererandomlydividedintothreegroups;namely,groupI(98patients)receivedomeprazole,clarithromycinandamoxicillin(OCA);groupII(97patients)receivedlansoprazole(LCA)andgroupIII(98patients)receivedesomeprazole(NCA)insteadofome-prazole.ResponsetotreatmentwasdefinedaseradicationofH.pyloriconfirmedbynegativeC14ureabreathtest40daysaftertreatmentcoursecompletion.Results:Perprotocol(PP)eradicationrateofH.pyloriwas91.9%forgroupI,80.4%forgroupIIand91.8%forgroupIII(P=0.017).Intentiontotreat(ITT)eradicationrateforgroupsI,IIandIIIwere91%,78%and90%,respectively(P=0.012).Thepatientsa€?compliancewas99%,97%and98%andtheadverseeventswere36%,35%and14%inthesethreegroups,respectively(P=0.614)(P=0.001).Basedonageandsex,eradicationrateshowedsignificantdifferencewithoutconsideringvarioustreatmentprotocols(P=0.017and0.031,respectively).TherewasnodifferenceineradicationratebetweenPUDandNUDpatients(P=0.166).Conclusions:BothPPandITTeradicationrateswerehigherintheOCAandNCAtreatmentgroups.GroupIIIhadtheleastadverseeffects.EradicationbyNCAregimenhadlesssideef-fectsbutmorecostcomparedtoOCAregimen