The outcome of a 2-week treatment of Helicobacter pylori-positive duodenal ulcer with omeprazole-based antibiotic regimen in a region with high metronidazole resistance rate

Edward O. Adeyemi, Moheb F. Danial, Thanaa Helal, Sheela Benedict, Abdishakur Abdulle

Research output: Contribution to journalArticle

Abstract

Background/Objective. Metronidazole resistance is a major problem in many developing countries. Our main objective was to study the outcome of a non-metronidazole and omeprazole-based antibiotic regimen in eradicating Helicobacter pylori in patients with duodenal ulcer. Design. A prospective study of 50 consecutive patients with proven peptic ulcer (mean age 36.6 ± 10.5 years, range 17-60, male:female = 2), referred from the primary health centres. Main Outcome Measure. The primary outcome of the study was H. pylori eradication, at least 4 weeks after stopping antibiotic treatment. Methods. Patients were considered eligible for the study if they had endoscopic evidence or a past medical history of peptic ulcer and had not received any antibiotics for at least 4 weeks prior to admission into the study. H. pylori infection was confirmed by serology, histology, a rapid urease test (RUT) and culture. After an initial oesophago-gastroduodenoscopy (OGD), each patient received a 2-week course of omeprazole (20 mg twice daily), and each of amoxycillin capsules (500 mg) and clarithromycin tablets (250 mg) thrice daily after food. The follow-up OGDs were performed after a mean period of 10.04 weeks (range 4-48) and at 10.4 ± 2.5 months (range 6-14 months) after stopping treatment. Results. All 50 patients completed the study. The sensitivity values for serology, RUT and histopathology were 98, 96 and 100%, respectively. H. pylori culture was positive in only 15 of 50 patients (30% sensitivity). H. pylori was eradicated in 47 (94%) patients. There was no evidence of H. pylori infection in the 27 of 35 (77%) patients, who returned for a third OGD. At the time of the second OGD, there was a significant reduction of pain-days (from 5.47 to 1.16), and antral (from 1.95 to 0.78) and corpus (from 1.8 to 0.6) mucosal cellular infiltrate scores, when compared with the first OGD (P < 0.001 in each case). Conclusion. Exclusion of metronidazole from the treatment regimen of patients with H. pylori-positive duodenal ulcer in a region with metronidazole resistance yielded an excellent H. pylori eradication rate of 94%, when omeprazole, amoxicillin and clarithromycin were used.

Original languageEnglish (US)
Pages (from-to)1259-1263
Number of pages5
JournalEuropean Journal of Gastroenterology and Hepatology
Volume11
Issue number11
StatePublished - Jan 1 1999

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Omeprazole
Metronidazole
Duodenal Ulcer
Helicobacter pylori
Anti-Bacterial Agents
Clarithromycin
Therapeutics
Urease
Amoxicillin
Outcome Assessment (Health Care)
Helicobacter Infections
Serology
Peptic Ulcer
Developing Countries
Tablets
Capsules
Histology
Prospective Studies
Pain
Food

Keywords

  • Duodenal ulcer
  • Helicobacter pylori
  • Omeprazole-based antibiotic treatment

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The outcome of a 2-week treatment of Helicobacter pylori-positive duodenal ulcer with omeprazole-based antibiotic regimen in a region with high metronidazole resistance rate. / Adeyemi, Edward O.; Danial, Moheb F.; Helal, Thanaa; Benedict, Sheela; Abdulle, Abdishakur.

In: European Journal of Gastroenterology and Hepatology, Vol. 11, No. 11, 01.01.1999, p. 1259-1263.

Research output: Contribution to journalArticle

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abstract = "Background/Objective. Metronidazole resistance is a major problem in many developing countries. Our main objective was to study the outcome of a non-metronidazole and omeprazole-based antibiotic regimen in eradicating Helicobacter pylori in patients with duodenal ulcer. Design. A prospective study of 50 consecutive patients with proven peptic ulcer (mean age 36.6 ± 10.5 years, range 17-60, male:female = 2), referred from the primary health centres. Main Outcome Measure. The primary outcome of the study was H. pylori eradication, at least 4 weeks after stopping antibiotic treatment. Methods. Patients were considered eligible for the study if they had endoscopic evidence or a past medical history of peptic ulcer and had not received any antibiotics for at least 4 weeks prior to admission into the study. H. pylori infection was confirmed by serology, histology, a rapid urease test (RUT) and culture. After an initial oesophago-gastroduodenoscopy (OGD), each patient received a 2-week course of omeprazole (20 mg twice daily), and each of amoxycillin capsules (500 mg) and clarithromycin tablets (250 mg) thrice daily after food. The follow-up OGDs were performed after a mean period of 10.04 weeks (range 4-48) and at 10.4 ± 2.5 months (range 6-14 months) after stopping treatment. Results. All 50 patients completed the study. The sensitivity values for serology, RUT and histopathology were 98, 96 and 100{\%}, respectively. H. pylori culture was positive in only 15 of 50 patients (30{\%} sensitivity). H. pylori was eradicated in 47 (94{\%}) patients. There was no evidence of H. pylori infection in the 27 of 35 (77{\%}) patients, who returned for a third OGD. At the time of the second OGD, there was a significant reduction of pain-days (from 5.47 to 1.16), and antral (from 1.95 to 0.78) and corpus (from 1.8 to 0.6) mucosal cellular infiltrate scores, when compared with the first OGD (P < 0.001 in each case). Conclusion. Exclusion of metronidazole from the treatment regimen of patients with H. pylori-positive duodenal ulcer in a region with metronidazole resistance yielded an excellent H. pylori eradication rate of 94{\%}, when omeprazole, amoxicillin and clarithromycin were used.",
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AU - Helal, Thanaa

AU - Benedict, Sheela

AU - Abdulle, Abdishakur

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N2 - Background/Objective. Metronidazole resistance is a major problem in many developing countries. Our main objective was to study the outcome of a non-metronidazole and omeprazole-based antibiotic regimen in eradicating Helicobacter pylori in patients with duodenal ulcer. Design. A prospective study of 50 consecutive patients with proven peptic ulcer (mean age 36.6 ± 10.5 years, range 17-60, male:female = 2), referred from the primary health centres. Main Outcome Measure. The primary outcome of the study was H. pylori eradication, at least 4 weeks after stopping antibiotic treatment. Methods. Patients were considered eligible for the study if they had endoscopic evidence or a past medical history of peptic ulcer and had not received any antibiotics for at least 4 weeks prior to admission into the study. H. pylori infection was confirmed by serology, histology, a rapid urease test (RUT) and culture. After an initial oesophago-gastroduodenoscopy (OGD), each patient received a 2-week course of omeprazole (20 mg twice daily), and each of amoxycillin capsules (500 mg) and clarithromycin tablets (250 mg) thrice daily after food. The follow-up OGDs were performed after a mean period of 10.04 weeks (range 4-48) and at 10.4 ± 2.5 months (range 6-14 months) after stopping treatment. Results. All 50 patients completed the study. The sensitivity values for serology, RUT and histopathology were 98, 96 and 100%, respectively. H. pylori culture was positive in only 15 of 50 patients (30% sensitivity). H. pylori was eradicated in 47 (94%) patients. There was no evidence of H. pylori infection in the 27 of 35 (77%) patients, who returned for a third OGD. At the time of the second OGD, there was a significant reduction of pain-days (from 5.47 to 1.16), and antral (from 1.95 to 0.78) and corpus (from 1.8 to 0.6) mucosal cellular infiltrate scores, when compared with the first OGD (P < 0.001 in each case). Conclusion. Exclusion of metronidazole from the treatment regimen of patients with H. pylori-positive duodenal ulcer in a region with metronidazole resistance yielded an excellent H. pylori eradication rate of 94%, when omeprazole, amoxicillin and clarithromycin were used.

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