Published online Feb 14, 2024. doi: 10.3748/wjg.v30.i6.556
Peer-review started: October 6, 2023
First decision: November 12, 2023
Revised: November 26, 2023
Accepted: December 29, 2023
Article in press: December 29, 2023
Published online: February 14, 2024
Processing time: 122 Days and 1.7 Hours
A cure for Helicobacter pylori (H. pylori) remains a problem of global concern and none of the currently available treat
H. pylori eradication rate is significantly influenced by antibiotic resistance. According to the Maastricht VI consensus, the most recommended empirical regimens for H. pylori infection are Bismuth quadruple therapy and non-Bismuth quadruple concomitant therapy when the Bismuth agent is not available. Many studies showed that switching to high doses of second-generation proton-pump inhibitors (PPIs) and using a PPI-amoxicillin dual therapy can improve the eradication rate and could lead to fewer adverse effects (AEs). The cost of treatment is also a determining factor, especially in developing countries.
In the present study, we aimed to compare the results of the standard 10- and 14-d non-bismuth quadruple therapies to an optimized sequential therapy by using a second-generation PPI, in terms of efficacy, tolerability and cost-effectiveness. The 14-d sequential therapy using rabeprazole appears to be an optimal therapy that is comparable to 14-d concomitant therapy while causing fewer AEs and allowing a gain in terms of cost. Other studies could further validate the standard eradication regimens vs the 14-d sequential therapy using rabeprazole vs other regimens containing vonoprazan. For the moment, this molecule is still not available in Morocco.
We conducted a single center, prospective, open-label, randomized study with patients randomly assigned into three groups in a 1:1:1 ratio using a computer-generated table: QT-14, QT-10 and OST-14. Allocations were concealed in a sealed opaque envelope to be opened during the consultation day.
This study showed that the 14-d sequential therapy using rabeprazole appears to be an optimal therapy that is comparable to 14-d concomitant therapy while causing fewer AEs and allowing a gain in terms of cost.
According to the Maastricht VI consensus, the most recommended empirical regimens for H. pylori infection are Bismuth quadruple therapy and non-Bismuth quadruple concomitant therapy. This study suggests the use of an optimized 14-d sequential regimen using rabeprazole to achieve the same eradication rate as the non-bismuth quadruple concomitant therapy while leading to fewer AEs and being more economically attractive.
Given our study’s limitations, these are several future research perspectives: (1) Conduct a multicenter trial (in different geographical areas) to validate our results; (2) Compare the sequential therapy to other therapies containing vonoprazan; and (3) Compare the use of esomeprazole and rabeprazole in a sequential therapy in terms of efficacy, tolerability and cost-effectiveness.