Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2025; 31(7): 97401
Published online Feb 21, 2025. doi: 10.3748/wjg.v31.i7.97401
Declining eradication rates of Helicobacter pylori with standard triple therapy in Addis Ababa, Ethiopia
Mahlet Tsige Weldeamanuel, Rezene Berhe, Hiwot Belachew, Gebeyehu Tessema Azibte, Zekarias Seifu Ayalew, Amira Abrar Mohammed, Yemisrach Kifle Shewangizaw
Mahlet Tsige Weldeamanuel, Rezene Berhe, Hiwot Belachew, Gebeyehu Tessema Azibte, Zekarias Seifu Ayalew, Amira Abrar Mohammed, Yemisrach Kifle Shewangizaw, Internal Medicine, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
Co-first authors: Mahlet Tsige Weldeamanuel and Rezene Berhe.
Co-corresponding authors: Gebeyehu Tessema Azibte and Zekarias Seifu Ayalew.
Author contributions: Weldeamanuel MT, Berhe R, and Belachew H contributed to conceptualization, methodology, investigation, statistical analysis, and writing the original manuscript; Azibte GT, Ayalew ZS contributed to methodology, data curation, drafting, interpretation, and edition of the manuscript; Mohammed AA, Shewangizaw YK contributed to methodology, supervision, and edition of the manuscript.
Institutional review board statement: The study was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board of Addis Ababa University, College of Health Sciences protocol code 61/23 on May 16, 2023.
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gebeyehu Tessema Azibte, MD, Internal Medicine, College of Medicine and Health Sciences, Addis Ababa University, Churchill, Addis Ababa 1000, Ethiopia. gebe10tessema@gmail.com
Received: May 29, 2024
Revised: December 13, 2024
Accepted: December 27, 2024
Published online: February 21, 2025
Processing time: 235 Days and 21.4 Hours
Abstract
BACKGROUND

Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection, but it is encountered with drug resistance. The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H. pylori, 4-8 weeks post-therapy, with 86% sensitivity and 92% specificity.

AIM

To assess the H. pylori eradication rate of standard triple therapy and factors affecting the eradication rate.

METHODS

We conducted a prospective, multicenter follow-up study in Addis Ababa, Ethiopia, at selected healthcare facilities among dyspeptic patients with positive stool H. pylori antigen tests from June 1, 2023 to October 30, 2023 to assess the H. pylori eradication rate. After completing the standard triple therapy, the eradication was confirmed using a stool antigen test 4 weeks later. The data were analyzed using bivariate and multivariate logistic regression methods.

RESULTS

The H. pylori eradication rate was 85.4%. Patients with a previous diagnosis of H. pylori infection, smokers, and local alcohol consumption were associated with a lower H. pylori eradication rate, with adjusted odds ratio (AORs) of 0.159 [95% confidence interval (CI): 0.050-0.511], 0.206 (95%CI: 0.052-0.822), and 0.228 (95%CI: 0.052-0.997), respectively. Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement, AOR = 5.383, 95%CI: 1.74-21.089.

CONCLUSION

H. pylori eradication rate was lower than expected. Post-treatment testing is crucial to confirm eradication and guide further management, such as susceptibility testing.

Keywords: Helicobacter pylori; Triple therapy; dyspepsia; Proton pump inhibitor; Stool antigen test

Core Tip: Standard triple therapy for Helicobacter pylori eradication showed a lower success rate (85.4%) in Addis Ababa, Ethiopia, compared to previous studies. Patients with prior H. pylori diagnosis, smoking, and local alcohol consumption had a lower eradication rate. Complete symptom resolution was associated with higher eradication success. This suggests the need for routine eradication confirmation tests and monitoring for symptom improvement.