Comparison of Helicobacter Pylori Eradication Regimens in Patients with End Stage Renal Disease
Aim: The aim of this study was to compare the Helicobacter pylori (HP) eradication regimens in patients with end stage renal disease.
Background: In patients undergoing hemodialysis, the pathologic changes seen in the stomach may be the result of high serum levels of gastrin, delayed gastric emptying or HP infection.
Methods: Our study was a randomized clinical trial in which 120 patients with ESRD (Patients who undergo hemodialysis) confirmed HP infection, were divided to four groups having 2-week eradication regimens; Group I: LCA (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD, amoxicillin 500 mg-BD), Group II: LCM (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD, metronidazole 500 mg-BD), Group III: LCAM (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD,amoxicillin 500 mg-BD, metronidazole 500 mg-BD) and Group IV: Sequential (lansoprazole 30 mg-BDfor two weeks; first week: amoxicillin 500 mg-BD and second week: clarithromycin 250 mg-BD, metronidazole 500 mg-BD).6 weeks after treatment, Urea Breath Test (UBT) was performed for all patients.
Results: The mean age of patients was 43.1±11.2 years. 55.8% of patients were male. The success rates of HP eradication in 4 groups were76.7%, 70%, 90% and 90%, respectively. HP eradication rates were not statistically different among the regimens (p=0.11). There were not significant differences among the groups regarding demographic and anthropometric variables.
Conclusion: The results showed there was no significant difference between the success rates of HP eradication regimens for ESRD patients. According to approved regimen for 90% eradication rate, with a lower number of medications and given the less risk of side effects and drug interactions, the sequential regimen is the best.
Keywords: End Stage Renal Disease, Eradication therapy, Helicobacter pylori.
(Please cite as: Seyyed Majidi MR, Sanjari Pirayvatlou P, Rajabikashani M, Firoozabadi M, Seyed Majidi SA, Vafaeimanesh J. Comparison of Helicobacter pylori eradication regimens in patients with end stage renal disease. Gastroenterol Hepatol Bed Bench 2018;11(1):15-19).
Sachs G, Scott D R, WenY. Gastric infection by Helicobacter pylori. Current Gastroenterology Reports 2011;13 (6): 540-6.
Chiesa C, Pacifico L, Anania C, Poggiogalle E, Chiarelli F, Osborn JF. Helicobacter pylori therapy in children: overview and challenges. International Journal of Immunopathology and Pharmacology 2010;23 (2):405-16.
McColl KEL. Helicobacter pylori infection. The New England Journal of Medicine 2010;362 (17): 1597-1604.
Hunt RH, Xiao SD, Megraud F. World gastroenterology organisation global guideline: Helicobacter pylori in developing countries. Journal of Clinical Gastroenterology 2011;20 (3): 299-304.
Cultur AF. Diagnosing and managing of Helicobacter pylori infection. Med Lab Obs 1999;31: 22-9.
O’Connor A, Gisbert JP, McNamara D, O’Morain C. Treatment of Helicobacter pylori infection. Helicobacter 2011;16 (1): 53-8.
Malfertheiner P, Bazzoli F, Delchier JC. Helicobacter pylorieradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: arandomised, open-label, non-inferiority, phase 3 trial. Lancet 2011;377 (9769): 905-13.
Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Alimentary Pharmacology and Therapeutics 2007;26 (3): 343-57.
Chuah SK, Tsay FW, Hsu PI, Wu DC. A new look at anti-Helicobacter pylori therapy. World Journal of Gastroenterology 2011;17 (35): 3971-5.
Rimbara E, Fischbach LA, Graham DY. Optimal therapy for Helicobacter pylori infections. Nature Reviews Gastroenterology and Hepatology 2011;8 (2): 79-88.
Selgrad M, Malfertheiner P. Treatment of Helicobacter pylori. Current Opinion in Gastroenterology 2011;27 (6): 565-70.
Miura S, Hokari R. Seeking an optimal eradication therapy for Helicobacter pylori infection. Journal of Gastroenterology and Hepatology. 2012;27: 1-9.
Gen´e E, Calvet X, Azagra R, Gisbert JP. Triple vs. Quadruple therapy for treating Helicobacter pylori infection: an updated meta-analysis. Alimentary Pharmacology and Therapeutics. 2003;18(5): 543-4.
Seyyedmajidi M, Falaknazi K, Mirsattari D, Zojaji H, Roshani M, Lahmi F, et al. Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens. Arab J Gastroenterol. 2011 Sep;12(3):150-3.
Van Vlem B, Schoonjans R, Vanholder R,De vos M, Vandamme W, Van Laecke S, et al. Delayed gastric emptying indyspeptic chronic hemodialysis patients. Am J Kidney Dis 2000;36(5):962–8.
Karari EM, Lule GN, McLigeyo SO, Amayo EO. Endoscopic findings and the prevalence
of Helicobacter pylori in chronic renal failure patients with dyspepsia. East AfrMed J 2000;77(8):406–9.
Jabbari M, TalebiTaher M, AgahSh, Mohammadi M, Jenabi A. Accuracy of urea breath test to detect Helicobacter pylori infection among patients with chronic renal failure candidate for renal transplantation. Medical Journal of Islamic Azad University. 2010;20(2): 126-130. [Persian]
Tseng GY, Lin HJ, Fang CT, Yang HB, Tseng GC, Wang PC, et al. Recurrence of peptic ulcer in uraemic and non-uraemic patients after Helicobacter pylori eradication: a 2-year study. Aliment PharmacolTher 2007;26 (6): 925-33.
Itatsu T, Miwa H, Nagahara A, Kubota M, Miyazaki A, Sato N, et al. Eradication of Helicobacter pylori in hemodialysis patients. Ren Fail 2007;29 (1): 97-102.
Mehrabian AA, Homayooni SM, Nasrollahi AR, Zojaji H, Hamasi Y. Association of chronic renal failure with peptic ulcer and Helicobacter pylori infection. Journal of Arak University of medical Sciences 2004;6 (4): 40-5. [Persian]
Sugimoto M, Yamaoka Y. Review of Helicobacter pylori infection and chronic renal failure. TherApher Dial 2011;15(1): 1-9.
Matini M. Prevalence of Helicobacter pylori in patients with chronic renal failure undergoing hemodialysis with gastrointestinal disorders. Feyz 2005;32: 39-42. [Persian]
Watanabe H, Hiraishi H, Ishida M. Pathophysiology of gastric acid secretion in patients with chronic-renal failure: influence of Helicobacter pylori infection. J Intern Med 2003;254 (5): 439-46.
Sotoudehmanesh R, Ali Asgari A. Endoscopic findings in end stage renal disease. Endoscopy 2003;35 (6): 502-5.
Asl MK, Nasri H. Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia. Saudi J kidney Dis Transpl 2009;20: 223-26.
Korzonek M, Szymaniak L, Giedrys-Kalemba S. Is it necessary to treat Helicobacter pylori infection in patients with end stage renal failure and in renal transplant.recipients?. Pol Arch Med 2004;111 (3): 297-304.
Nakajima F, Sakaguchi M, Oka H, Kawase Y, Shibahara N, Inoue T, et al. Prevalence of Helicobacter pylori antibodiesin long term dialysis patients. Nephrology 2004;9 (2): 73-76.
Fabrizi F, Martin P. Helicobacter pylori infection in patients with end-stage renal disease. Int J Artif Organs 2000;23 (3):157-64.
Luther J, Higgins PDR, Schoenfeld PS, et al. Empiric quadruple vs. triple therapy for primary treatment of Helicobacter pylori infection: systematic review and meta-analysis of efficacy and tolerability. Am J Gastroenterol 2010;105 (1): 65-73.
Graham DY. Efficient identification and evaluation of effective Helicobacter pylori therapies.ClinGastroenterol. Hepatol 2009;7 (2): 145-8.
Aydemir S, Boyacioglu S, Gur G, Demirbilek M, Can FK, Korkmaz M, Yilmaz U. Helicobacter pylori infection in hemodialysis patients: susceptibility to amoxicillin and clarithromycin. World J Gastroenterol 2005;11 (6): 842-5.
Mak SK, Loo CK, Wong AM, Wong PN, Lo KY, Tong GM, et al. Efficacy of a 1-week course of proton-pump inhibitor-based triple therapy for eradicating Helicobacter pylori in patients with and without chronic renal failure. Am J Kidney Dis 2002;40 (3): 576-81.
Sheu BS, Huang JJ, Yang HB, Huang AH, Wu JJ.The selection of triple therapy for Helicobacter pylori eradication in chronic renal insufficiency. Aliment PharmacolTher 2003;17 (10): 1283-90.
Gür G, Boyacioglu S, Gül C, Turan M, Gürsoy M, Baysal C, et al. Impact of Helicobacter pylori infection on serum gastrin in haemodialysis patients. Nephrol Dial Transplant 1999;14 (11): 2688-91.