Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 227-235
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.227
Zinc carnosine-based modified bismuth quadruple therapy vs standard triple therapy for Helicobacter pylori eradication: A randomized controlled study
Nour Ibrahim, Hassan El Said, Ali Choukair
Nour Ibrahim, Faculty of Medical Sciences, Lebanese University, Beirut 0000, Lebanon
Hassan El Said, Department of Biological and Chemical Sciences, School of Arts and Sciences, Lebanese International University, Beirut 0000, Lebanon
Ali Choukair, Department of Gastroenterology, Clemenceau Medical Center, Dubai 00000, United Arab Emirates
Author contributions: Choukair A designed the study, collected the data and wrote the first draft of the manuscript; Ibrahim N analyzed the data and contributed to the manuscript writing; all authors critically revised the manuscript and read and approved the final version of the manuscript.
Supported by Synergy Group
Institutional review board statement: This study was reviewed and approved by the Clinical Research Ethics Committee of NMC specialty hospital.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
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: Nour Ibrahim, MD, Research Fellow, Faculty of Medical Sciences, Lebanese University, Old Saida Road Street, Hadath Area, Beirut 0000, Lebanon.nouribrahim5@hotmail.com
Received: June 25, 2021
Peer-review started: June 25, 2021
First decision: July 27, 2021
Revised: August 7, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: January 7, 2022
Processing time: 187 Days and 14.9 Hours
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) infection is a worldwide problem with increasing burden on the health sector due to its increasing rate of resistance. The conventional triple therapy (TT) is becoming obsolete with a high failure rate of eradication, necessitating the need for better alternatives or regimens.

AIM

To investigate H. pylori eradication rate of TT vs modified bismuth quadruple therapy.

METHODS

Ninety-two patients with dyspepsia symptoms and positive 13C-urea breath test were randomly assigned to two groups. The first group (control group) was treated for 14 d using standard TT protocol: Esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). On the other hand, the second group was prescribed a 10-d course of modified bismuth quadruple therapy fortified with zinc carnosine: TT in addition to bismuth subcitrate (240 mg twice daily) and zinc carnosine (75 mg twice daily). A repeated 13C-urea breath test was done 4 wk after the completion of the eradication therapy.

RESULTS

Among the 92 subjects, 67.4% were males and 32.6% were females. There were no differences in demographic characteristics (age, body mass index, smoking history, previous antibiotics use and ethnicity) between the modified bismuth quadruple therapy group and TT group. The eradication rate was higher [93.5% (43/46)] in the modified bismuth quadruple therapy group compared to 69.6% (32/46) in the standard TT group (P = 0.003). Of the tested predictor variables, only nationality, smoking and therapy type were statistically significant. Besides dizziness, which was recorded in modified bismuth quadruple therapy group, there were no significant differences in side effects between the two groups.

CONCLUSION

Ten days of modified bismuth quadruple therapy fortified with zinc carnosine is superior to 14 d of conventional TT in eradicating H. pylori infection, with no additional significant adverse events.

Keywords: Helicobacter pylori; Polaprezinc; Bismuth; Peptic ulcer; Gastritis; Drug Resistance; Microbial

Core Tip: High eradication failure rate of Helicobacter pylori (H. pylori) infection has been reported due to increasing antibiotic resistance. This necessitates the need for better alternative regimens. The present study revealed higher H. pylori eradication rate with the use of zinc carnosine-based modified bismuth quadruple therapy for 10 d than with 14 d of standard triple therapy.