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Aim: To investigate whether the sequential therapy composed of high dose omeprazole and high dose amoxicillin in the first step was effective in eradication of H. pylori and whether there was a relation between effectiveness of the therapy and CYP2C19 gene polymorphism., Method: 134 dyspeptic patients with H. pylori were administered a modified sequential therapy composed of omeprazole 40 mg t.i.d. and amoxicillin 1000 mg t.i.d, for the first five days followed by omeprazole 20 mg b.d., metronidazole 500 mg t.i.d. and tetracycline 500 mg t.i.d, for the next five days. CYP2C19 genotype status was determined in patients. Hp eradication status was investigated by C14 UNT four weeks after treatment., Results: The eradication rates were 64.9% in ITT and 74.3% in PP analysis. In subgroup analyses, eradication rates were 73.8% and 60.8% (p: 0.145) in ITT for peptic ulcer and non-ulcer dyspepsia patients respectively and 86.1% and 69.1% (p: 0.052) in PP analysis for peptic ulcer and non-ulcer dyspepsia patients respectively. The difference was not significant. As for the CYP2C19 gene status, 81.5% of the patients had HoEM and 17.3% of the patients had HeEM, and eradication rates were 72% and 75% in ITT analysis for HoEM and HeEM respectively (p: 0.803) and 73.9% and 85.7% in PP analysis for HoEM and HeEM respectively (p: 0.347). There was not a significant difference in H. pylori eradication rates between the two groups., Conclusion: This modified high-dose sequential therapy was ineffective in a Turkish sample, nearly all of whom had EM in terms of CYP2C19 gene status.

Background: Standard triple therapy for Helicobacter pylori has an eradication rate of about 50% in Turkey. It may be due to an increased resistance of H. pylori to antibiotics. Therefore, we aimed to investigate the effectiveness of a new second-generation fluoroquinolone, moxifloxacin-containing triple therapy in H. pylori eradication., Material and Methods: This is an open-label, prospective, single-center, pilot study. We studied 71 dyspeptic patients infected with H. pylori diagnosed by both histology and rapid urease test. Out of 71 dyspeptic patients, 64 had non-ulcer dyspepsia and seven had peptic ulcer. Patients received pantoprazole (40 mg b.i.d.) plus moxifloxacin (400 mg/day) and amoxicillin (1000 mg b.i.d.) for 14 days. Eradication was assessed 4 weeks after completing the therapy by histology and rapid urease test. Per-protocol and intention-to-treat eradication rates were determined., Results: The eradication rate was 42.2% for the intention-to-treat analysis and 47.6% for the per-protocol analysis. Of all patients included in the study, 29.5% had side-effects and only 2.8% of the patients discontinued the treatment because of side-effects. Most of the complications were mild and self-limiting., Conclusion: Triple therapy with pantoprazole, moxifloxacin, and amoxicillin for 14 days yielded unacceptably low eradication rates. However, using tests of susceptibility to antibiotics, further studies with larger sample sizes are needed to judge these eradication rates of moxifloxacin containing eradication treatment.

Background/aims: Helicobacter pylori is the most common infectious disease all over the world. Ten to twenty percent of the patients remain infected despite treatment with proton pump inhibitors (PPIs), amoxicillin and clarithromycin. We compared PPI, bismuth, tetracycline and metronidazole with ranitidine bismuth citrate, tetracycline and metronidazole in cases resistant to PPIs-based triple therapies., Methods: The study included 52 patients who underwent a triple therapy with PPI, clarithromycin and amoxicillin for 14 days between September 2001 and December 2002, and were found to be resistant to the therapy. They were randomized to take ranitidine bismuth citrate (Rb) 400 mg twice a day, tetracycline (T) 1 g twice a day and metronidazole (M) 500 mg three times a day for 14 days (RbTM), or ranitidine bismuth citrate (Rb) 400 mg twice a day for 14 days and azithromycin (A) 500 mg once a day for 7 days (RbA). Four weeks after the treatment, endoscopies were repeated, and patients were assessed with respect to changes in symptoms. When H. pylori was negative on histological analysis and urease test, eradication was achieved., Results: A total of 52 patients, 32 females and 20 males with a mean age of 49+/-12 years, were included in the study. Eradication was achieved in 15 (28%) out of 52 patients in total. There was a significant difference between RbA and RbTM groups (p=0.01). In fact, H. pylori was eradicated in 3 (12%) out of 25 patients in the RbA group, whereas it was eradicated in 12 (44.4%) out of 27 patients in the RbTM group. Symptom scores significantly improved in both groups after the treatment, though there was not a significant difference between the groups (p=0.705)., Conclusions: Triple therapy including azithromycin does not seem to be a good choice in cases resistant to the first line therapies; however, a similarly lower rate of eradication was achieved with the quadruple therapy proposed. Therefore, different treatment schemes should be applied in resistant patients, and further studies are needed as well.