Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2021; 27(31): 5247-5258
Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5247
Tailored eradication strategy vs concomitant therapy for Helicobacter pylori eradication treatment in Korean patients
Youn I Choi, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim, Jung Ho Kim, Ja Young Seo, Dong Kyun Park
Youn I Choi, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim, Jung Ho Kim, Dong Kyun Park, Division of Internal Medicine, Department of Gastroenterology, Gachon University College of Medicine, Gil Medical Center, Inchoen 21565, South Korea
Ja Young Seo, Department of Laboratory Medicine, Gil Medical Center, Gachon University, Inchoen 21565, South Korea
Dong Kyun Park, Health IT Research Center, Gachon University Gil Hospital, Incheon 21565, South Korea
Author contributions: Chung JW contributed to the study concept and design, coordinated all of the study processes as the corresponding authors; Choi YI and Seo JY analyzed the data; Choi YI interpreted the data; Choi YI and Chung JW drafted the manuscript; Park DK, Kim KO, Kwon KA, Kim JH, and Kim YJ critically revised the manuscript for important intellectual content; all the authors approved the submitted draft.
Supported by National Research Foundation of Korea (NRF) funded by the Ministry of Education, No. NRF-2020R1F1A1076839.
Institutional review board statement: The Institutional Review Board of the Gil Medical Center (GMC) reviewed the study protocol and ethics. This study was conducted in accordance with the Declaration of Helsinki, and the study protocol was approved by the ethics committee of the GMC.
Informed consent statement: Patients were not required to give the informed consent to the study because the analysis used the anonymous data that were collected after each patient agreed to treatment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request at (
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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:
Corresponding author: Jun-Won Chung, MD, PhD, Professor, Division of Internal Medicine, Department of Gastroenterology, Gachon University College of Medicine, Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, South Korea.
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: June 3, 2021
Revised: July 9, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: August 21, 2021
Research background

Antibiotic resistance to Helicobacter pylori (H. pylori) infection has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for H. pylori infection has got attention.

Research motivation

However, there is limited data regarding efficacy of TT strategy in treatment of H. pylori infection in Korea as compared to that of concomitant therapy (CT) regimen.

Research objectives

To investigate the efficacy and safety profiles of TT for H. pylori infection treatment compared to a non-bismuth quadruple therapy, CT.

Research methods

We included treatment naive H. pylori infection patients (> 18 years) who visited the Gil Medical Center between March 2016 and October 2020. After randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were compared between the two groups. For the TT group, a dual priming oligonucleotide polymerase chain reaction (DPO-PCR) test, which detected A2142G and/or A2143G point mutations, and a clarithromycin (CLR) resistance test were performed. Patients in the CLR-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen.

Research results

Of the 217 patients with a treatment naive H. pylori infection, 110 patients [mean age: 58.66 ± 13.03, men, n = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, n = 52 (48.60%)] were treated with CT. The compliance (TT vs CT, 100% vs 98.13%, P = 0.30), and follow-up loss rates (8.18% vs 9.35%, P = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT vs CT, 82.73% vs 82.24%, P = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% vs 50.52%, P < 0.001).

Research conclusions

The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistance rates.

Research perspectives

The DPO-based TT regimen might role as a first-line Helicobacter eradication regimen with similar efficacy and safety profiles as compared to CT regimen.