Eradication Rates for Esomeprazole and Lansoprazole-Based 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Anti-Helicobacter pylori Treatment in Real World Clinical Practice

Kuo-Tung Hung,1 Shih-Cheng Yang,1 Cheng-Kun Wu,1,2 Hsing-Ming Wang,1 Chih-Chien Yao,1 Chih-Ming Liang,1,2 Wei-Chen Tai,1,2 Keng-Liang Wu,1,2 Yuan-Hung Kuo,1,2 Chen-Hsiang Lee,2,3 Seng-Kee Chuah1,2 1Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Chang Gung University, College of Medicine, Taoyuan, Taiwan; 3Division of Infectious Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, TaiwanCorrespondence: Seng-Kee Chuah; Chih-Ming LiangDivision of Hepatogastroenterology, Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, 833, TaiwanTel + 886-7-7317123 ext. 8301Fax + 886-7-7322402Email chuahsk@seed.net.tw; gimy54861439@gmail.comPurpose: Non-bismuth concomitant quadruple therapy is commonly administered in Taiwan, achieving an acceptable efficacy as a first-line anti-Helicobacter pylori treatment. This study compared the eradication rates between esomeprazole- and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line anti-H. pylori treatment.Patients and Methods: This study included 206 H. pylori-infected naïve patients between July 2016 and February 2019. The patients were prescribed with either a 7-day non-bismuth containing quadruple therapy (esomeprazole, 40 mg twice daily; amoxicillin, 1 g twice daily; and metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily for 7 days [EACM group]; lansoprazole, 30 mg twice daily; amoxicillin, 1 g twice daily; metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily [LACM group]). Then, the patients were asked to perform urea breath tests 8 weeks later.Results: The eradication rates in the EACM group were 86.1% (95% confidence interval [CI], 77.8%– 92.2%) and 90.6% (95% CI, 82.9%– 95.6%) in the intention-to-treat (ITT) and the per-protocol (PP) analyses, respectively. Moreover, the eradication rates in the LACM group were 90.1% (95% CI, 82.6%– 95.2%) and 92.6% (95% CI, 85.5%– 96.9%) in the ITT and the PP analyses, respectively. Consequently, the LACM group exhibited more diarrhea patients than the EACM group (7.1% versus 1.0%, p = 0.029), but all symptoms were mild. Univariate analysis in this study showed that metronidazole-resistant strains were the clinical factor affecting the eradications (95.3% versus 78.9%, p = 0.044). Moreover, a trend was observed in dual clarithromycin- and metronidazole-resistant strains (91.5% versus 66.7%, p = 0.155).Conclusion: The eradication rates between esomeprazole and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line H. pylori treatment were similar in this study. Both could achieve a > 90% report card in the PP analysis.Keywords: Helicobacter pylori, esomeprazole, lansoprazole, concomitant therapy, antibiotic resistance