Concomitant therapy achieved the best eradication rate for Helicobacter pylori among various treatment strategies

Table 1 Characteristics of patients n (%)

	PAC group	PAM group	Sequential	Concomitant	P value
	(n = 170)	(n = 170)	(n = 170)	(n = 170)
Age, yr	55.6 ± 13.6	57.4 ± 12.8	58.3 ± 12.3	55.8 ± 12.6	0.1031
Gender					0.0602
Male	102 (60.0)	107 (62.9)	110 (64.7)	106 (62.4)
Female	68 (40.0)	63 (37.1)	60 (35.3)	64 (37.7)
Diagnosis					0.5532
Gastric ulcer	81 (47.7)	77 (45.3)	86 (50.6)	78 (45.9)
Duodenal ulcer	36 (21.2)	28 (16.5)	32 (18.8)	27 (15.9)
Gastritis	53 (31.2)	65 (38.2)	52 (30.6)	65 (38.2)

¹1-way ANOVA test;

²χ² test. PAC: Rabeprazole, amoxicillin and clarithromycin; PAM: Rabeprazole, amoxicillin and metronidazole.

Table 2 First-line eradication rates of Helicobacter pylori

	Achieved/analyzed patients (n)	Eradication rate, (95%CI)	P value1	P value2
Per protocol			0.001
PAC (n = 143)	109/143	76.2% (69.3-83.2)		< 0.001
PAM (n = 139)	117/139	84.2% (78.1-90.2)		0.016
Sequential (n = 141)	119/141	84.4% (78.4-90.4)		0.018
Concomitant (n = 143)	135/143	94.4% (90.6-98.2)		-
Intent-to-treat			0.001
PAC (n = 170)	109/170	64.1% (58.8-73.0)		0.007
PAM (n = 170)	117/170	68.8% (66.3-79.2)		0.285
Sequential (n = 170)	119/170	70.7% (65.0-78.5)		0.169
Concomitant (n = 170)	135/170	79.4% (74.6-86.5)		-

¹P-value of χ² test;

²Bonferroni adjusted P-value of χ² test on 2 × 2 subtables. PAC: Rabeprazole, amoxicillin and clarithromycin; PAM: Rabeprazole, amoxicillin and metronidazole.

Table 3 Second-line eradication rates of Helicobacter pylori

	Achieved/analyzed patients (n)	Eradication rate (95%CI)	P value1
Per protocol			0.351
PAC (n = 31)	27/31	87.1% (75.3-98.9)
PAM (n = 24)	22/24	91.7% (80.6-100)
Sequential (n = 25)	20/25	80.0% (64.3-95.9)
Concomitant (n = 10)	7/10	70.0% (34.8-93.3)
Intent-to-treat			0.657
PAC (n = 36)	27/36	75.0% (60.9-89.1)
PAM (n = 27)	22/27	81.5% (66.8-96.1)
Sequential (n = 25)	20/25	80.0% (64.3-95.9)
Concomitant (n = 11)	7/11	63.6% (35.2-92.1)

¹P-value of χ² test. PAC: Rabeprazole, amoxicillin and clarithromycin; PAM: Rabeprazole, amoxicillin and metronidazole.

Table 4 Third-line eradication rates of Helicobacter pylori

	Achieved/analyzed patients (n)	Eradication rate (95%CI)	P value1
Treatment group			0.052
PAC (n = 4)	3/4	75.0 (19.4-99.4)
PAM (n = 2)	2/2	100.0 (15.8-100)
Sequential (n = 5)	1/5	20.0 (0.5-71.6)
Concomitant (n = 3)	0/3	0.0 (0.0-70.8)

¹P-value of χ² test. PAC: Rabeprazole, amoxicillin and clarithromycin; PAM: Rabeprazole, amoxicillin and metronidazole.

Table 5 Factors affecting eradication of Helicobacter pylori n (%)

Factors	Eradicated	Not	Crude OR(95%CI)	P valuea	Adjust OR(95%CI)	P value1
Age	56.8 ± 12.9	57.6 ± 11.9	0.996	0.632
			(0.978-1.014)
Gender
Male	294	34	-	-	-	-
	(61.25)	(39.53)
Female	186	52	0.414	0.080
	(38.75)	(60.47)	(0.259-0.662)
Diagnosis
Gastric ulcer	225	38	1.121	0.663
	(46.88)	(44.19)	(0.673-1.869)
Duodenal ulcer	86	16	1.018	0.896
	(17.92)	(18.60)	(0.529-1.957)
Gastritis	169	32	-	-
	(35.21)	(37.21)
Treatment Group
PAC	109	34	-	-	-	-
	(22.71)	(39.53)
PAM	117	22	1.659	0.430	1.738	0.559
	(24.38)	(25.58)	(0.914-3.012)		(0.948-3.187)
Sequential	119	22	1.687	0.478	1.636	0.386
	(24.79)	(25.58)	(0.930-3.062)		(0.894-2.997)
Concomitant	135	8	5.264	0.001	5.287	0.001
	(28.13)	(9.3)	(2.341-11.838)		(2.335-11.973)
Alcohol Intake
Yes	165	27	1.145	0.591
	(34.38)	(31.4)	(0.699-1.874)
No	315	59	-	-
	(65.63)	(68.6)
Smoking
Smoker	127	18	1.359	0.281
	(26.46)	(20.93)	(0.778-2.374)
Non-smoker	353	68	-	-
	(73.54)	(79.07)
BMI	22.7 ± 2.7	22.2 ± 2.9	1.073	0.107
			(0.985-1.169)
Total Cholesterol	188.2 ± 39.9	188.8 ± 35.1	1.000	0.914
			(0.993-1.007)
LDL Cholesterol	107.3 ± 32.5	109.8 ± 31.8	0.998	0.601
			(0.989-1.007)

¹P-value of Wald test for coefficients of logistic regression. PAC: Rabeprazole, amoxicillin, clarithromycin; PAM: Rabeprazole, amoxicillin, metronidazole; BMI: Body mass index; LDL: Low density lipoprotein.

Table 6 Incidence of adverse drug reactions n (%)

	PAC	PAM	Sequential	Concomitant	P value1
	(n = 170)	(n = 170)	(n = 170)	(n = 170)
Patients with side effect	86 (50.6)	82 (48.2)	70 (41.2)	69 (40.6)	0.158
	(43.07, 58.10)	(40.72, 55.75)	(33.78, 48.57)	(33.21, 47.97)
Total side effects (n)	101	93	83	96
Side effect
Abdominal bloating	2 (1.18)	5 (2.94)	0 (0.00)	0 (0.00)	7 (1.03)
Abdominal pain	8 (4.71)	11 (6.47)	0 (0.00)	0 (0.00)	19 (2.79)
Bitter taste	28 (16.47)	10 (5.88)	11 (6.47)	16 (9.41)	65 (9.56)
Constipation	0 (0.00)	6 (3.53)	0 (0.00)	1 (0.59)	7 (1.03)
Dizziness	4 (2.35)	3 (1.76)	3 (1.76)	1 (0.59)	11 (1.62)
Dyspepsia	5 (2.94)	15 (8.82)	13 (7.65)	13 (7.65)	46 (6.76)
Epigastric pain	6 (3.53)	0 (0.00)	11 (6.47)	21 (12.35)	38 (5.59)
General weakness	2 (1.18)	3 (1.76)	2 (1.18)	2 (1.18)	9 (1.32)
Halitosis	0 (0.00)	0 (0.00)	1 (0.59)	1 (0.59)	2 (0.29)
Headache	4 (2.35)	3 (1.76)	3 (1.76)	4 (2.35)	14 (2.06)
Loose stool	24 (14.12)	2 (1.18)	17 (10.00)	19 (11.18)	62 (9.12)
Loss of appetite	6 (3.53)	3 (1.76)	1 (0.59)	0 (0.00)	10 (1.47)
Nausea	12 (7.06)	32 (18.82)	20 (11.76)	15 (8.82)	79 (11.62)
Oral ulcer	0 (0.00)	0 (0.00)	1 (0.59)	0 (0.00)	1 (0.15)
Skin eruption	0 (0.00)	0 (0.00)	1 (0.59)	0 (0.00)	1 (0.15)
Sleeping tendency	0 (0.00)	0 (0.00)	0 (0.00)	1 (0.59)	1 (0.15)
Vomiting	0 (0.00)	0 (0.00)	3 (1.76)	3 (1.76)	6 (0.88)

¹P-value of χ² test. PAC: Rabeprazole, amoxicillin, clarithromycin; PAM: Rabeprazole, amoxicillin, metronidazole.