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Korean J Helicobacter  Up Gastrointest Res > Volume 14(4); 2014 > Article
The Korean Journal of Helicobacter  and Upper Gastrointestinal Research 2014;14(4):249-254.
DOI: https://doi.org/10.7704/kjhugr.2014.14.4.249    Published online December 10, 2014.
The Effect of Concomittent Therarpy and Quadruple Therapy for Patients Who Had 23S Ribosomal Ribonucleic Acid Mutated Helicobacter pylori in Daegu and Kyoungpook Area
Min Kyu Jung, Jae Kwang Lee, Jun Heo, Eun Jeong Kang, Yu Rim Lee
Department of Internal Medicine, Kyungpook National University School of Medicine, Daeugu, Korea. minky1973@hanmail.net
대구, 경북 지역에서 23S rRNA 점 돌연변이와 관련된Clarithromycin 내성 Helicobacter pylori 감염 환자에서동시 치료 및 2차 표준 제균 치료의 효과
정민규, 이재광, 허 준, 강은정, 이유림
경북대학교 의학전문대학원 내과학교실
Abstract
BACKGROUND/AIMS
Proton pump inhibitor (PPI) and two types of antimicrobial agents, amoxicillin, and clarithromycin have been widely used for the eradication of Helicobacter pylori. However, antibiotic resistant strains has rapidly increased and has emerged as an important factor for eraducation failure. MATERIALS AND METHODS: Patients diagnosed with chronic gastritis, peptic ulcer disease or gastric epithelial neoplasm was examined by H. pylori PCR for mutation at 23S rRNA. Positive H. pylori PCR without 23S rRNA mutation was eradicated by standard triple therapy. Patients with 23S rRNA mutation was eradicated by standard triple therapy or concomittent therapy with amoxicillin, PPI, clarithromycin and metronidazol or quadruple therapy with bismuth, PPI, tetracycline and metronidazol. We evaluated the predictors of eradication failure with regards to 23S rRNA mutation and initial eradication regimen. RESULTS: Nine hundred sixty-one patients were studied. H. pylori PCR was positive in 35.0% of the patients and 23S rRNA mutatation was found in 22.2% of the patients. The eradication rate of H. pylori for the A2143G point mutated group with standard triple therapy was 28.5% and significantly lower than 93.1% of the wild type group and 100% of the concomitant therapy group, 66.6% of one week quadruple group and 100% of two week quadruple group (P<0.005). CONCLUSIONS: When 23S rRNA point mutation was positive, the standard triple therapy was not effective and the eradication rates was only 22.2%. Alternative regimens should be considered when 23S rRNA point mutation is detected, especially when A2143G point mutation is detected because A2143G point mutation is highly related to eradication failure.
Key Words: Helicobacter pylori; 23S rRNA; Clarithromycin; Resistance
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