Letters To The Editor
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World J Gastroenterol. Jun 7, 2012; 18(21): 2735-2738
Published online Jun 7, 2012. doi: 10.3748/wjg.v18.i21.2735
Dual therapy for third-line Helicobacter pylori eradication and urea breath test prediction
Toshihiro Nishizawa, Hidekazu Suzuki, Takama Maekawa, Naohiko Harada, Tatsuya Toyokawa, Toshio Kuwai, Masanori Ohara, Takahiro Suzuki, Masahiro Kawanishi, Kenji Noguchi, Toshiyuki Yoshio, Shinji Katsushima, Hideo Tsuruta, Eiji Masuda, Munehiro Tanaka, Shunsuke Katayama, Norio Kawamura, Yuko Nishizawa, Toshifumi Hibi, Masahiko Takahashi
Toshihiro Nishizawa, Masahiko Takahashi, Division of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 1528902, Japan
Hidekazu Suzuki, Toshifumi Hibi, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 1608582, Japan
Takama Maekawa, Shinji Katsushima, Division of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto 6128555, Japan
Naohiko Harada, Division of Gastroenterology, National Kyushu Medical Center, Fukuoka 8108563, Japan
Tatsuya Toyokawa, Division of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama 7208520, Japan
Toshio Kuwai, Division of Gastroenterology, National Hospital Organization Kure Medical Center, Kure 7370023, Japan
Masanori Ohara, Division of Gastroenterology, National Hospital Organization Hakodate Medical Center, Hakodate 0418512, Japan
Takahiro Suzuki, Division of Gastroenterology, National Hospital Organization Maizuru Medical Center, Maizuru 6258502, Japan
Masahiro Kawanishi, Division of Gastroenterology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima 7390041, Japan
Kenji Noguchi, Division of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai 9838520, Japan
Toshiyuki Yoshio, Division of Gastroenterology, National Hospital Organization Osaka Medical Center, Osaka 5400006, Japan
Hideo Tsuruta, Division of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino 8430393, Japan
Eiji Masuda, Division of Gastroenterology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano 5868521, Japan
Munehiro Tanaka, Division of Gastroenterology, National Hospital Organization Fukuoka Higashi Medical Center, Koga 8113195, Japan
Shunsuke Katayama, Division of Gastroenterology, National Hospital Organization Yonago Medical Center, Yonago 6838518, Japan
Norio Kawamura, Division of Gastroenterology, National Hospital Organization Disaster Medical Center, Tachikawa 1900014, Japan
Yuko Nishizawa, Pharmaceutical Department, National Center for Global Health and Medicine, Tokyo 1658655, Japan
Author contributions: Nishizawa T designed the research project and originally drafted and revised the article; Suzuki H analyzed the data and critically drafted and revised the article; Maekawa T, Harada N, Toyokawa T, Kuwai T, Ohara M, Suzuki T, Kawanishi M, Noguchi K, Yoshio T, Katsushima S, Tsuruta H, Masuda E, Tanaka M, Katayama S and Kawamura N collected the data; Nishizawa Y, Hibi T and Takahashi M supervised and approved the final publication.
Supported by A grant from the National Hospital Organization, No. H21-NHO-01
Correspondence to: Hidekazu Suzuki, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan. hsuzuki@a6.keio.jp
Telephone: +81-3-53633914 Fax: +81-3-53633967
Received: December 19, 2011
Revised: February 28, 2012
Accepted: March 29, 2012
Published online: June 7, 2012
Abstract

We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)-AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to follow-up. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%, respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.

Keywords: Helicobacter pylori; Amoxicillin; Dual therapy; Eradication; Urea breath test