A Pilot Study of <i>Helicobacter pylori</i> Eradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Jung, Yun Duk; Kim, Yeon Ji; Chung, Woo Chul

doi:2017.17.4.200

Korean J Helicobacter Up Gastrointest Res > Volume 17(4); 2017 > Article

Original Article

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2017;17(4):200-207.
DOI: https://doi.org/10.7704/kjhugr.2017.17.4.200 Published online December 10, 2017.

A Pilot Study of Helicobacter pylori Eradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Yun Duk Jung, Yeon Ji Kim, Woo Chul Chung

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. dr.kimyj@gmail.com

Received: 20 July 2017 • Revised: 10 August 2017 • Accepted: 11 August 2017

Abstract

BACKGROUND/AIMS
Clarithromycin resistance is one of the main predictors of eradication treatment failures in Helicobacter pylori infections. The aim of this study was to investigate the ideal eradication rate of more than 90% of tailored therapies using a polymerase chain reaction (PCR)-based test for clarithromycin resistance in patients with peptic ulcer disease. In addition, we evaluated the possibility of sequential therapies for infections due to clarithromycin-resistant strains. MATERIALS AND METHODS: We prospectively enrolled patients referred to the gastroenterology unit for the evaluation and management of peptic ulcer from January 2012 to January 2014. Histology, a rapid urease test, and a dual-priming oligonucleotide-based multiplex (DPO)-PCR test were performed on gastric biopsy specimens. In the absence of 23S rRNA point mutations in H. pylori, the patients were treated with standard triple therapy, while in the presence of 23S rRNA point mutations, they were treated with sequential therapies. RESULTS: A total of 93 patients had peptic ulcer disease that was associated with H. pylori infections. These patients received eradication therapies, and 78 patients completed the therapies. The total eradication rate was 91% per protocol analysis, whereas it was 78.3% in patients treated with sequential therapies. CONCLUSIONS: The eradication rate of H. pylori with tailored therapies using the DPO-PCR test was acceptable. However, sequential therapies were not effective in patients who did not respond to clarithromycin.

Key Words: Clarithromycin; Helicobacter pylori; Polymerase chain reaction