OJGas  Vol.5 No.12 , December 2015
The Helicobacter pylori Eradication Rate in a High Prevalence Area (West Africa): Three Triple Therapy Comparative Study
In Western countries, the current trend is to use sequential quadruple therapy or bismuth-based instead of triple therapy for the eradication of Helicobacter pylori (H. pylori). In sub-Saharan Africa, high prevalence area of the H. pylori infection, the effectiveness of these triple therapies widely used in routine has been little evaluated. The purpose of this study was to evaluate and compare the effectiveness of three patterns of first-line triple therapy based on combining a proton pump inhibitors (PPI), and 3 types of antibiotics: omeprazole (O), amoxicillin (A), clarythromycin (C) and metronidazole (M). Patients and Methods: This is a randomized clinical trial opened on 3 parallel arms: OAM (group 1 or G1), OAC (group 2 or G2) or OCM (group 3 or G3). The primary endpoint was H. pylori eradication rate after seven days triple therapy. H. pylori diagnosis infection was based on bacterium detection on the histological examination of the gastric biopsies. Histological control was performed 4 weeks after the end of treatment to assess H. pylori eradication rate. Results: The average age of our 153 patients included in the study (86 men) was 44.33 ± 11.72 years. The main reason of the endoscopy was the dyspeptic syndrome (75.16%). The gastroscopy was normal in 28.76%. A Gastric or duodenal peptic ulcer was found in 17% of cases and gastropathy in 45.75%. Histologically, the GC was active in 90.9% of cases, follicular in 35.3% of cases, atrophic in 22.5% of cases and was associated with intestinal metaplasia (IM) in 5.2% of cases. Patients of these three groups (n = 64 for G1, n = 56 for G2 and n = 33 for G3) were comparable for age, gender, endoscopy indications, alcohol consumption history or smoking, and anti-inflammatory drugs taking. Approximately 23% of patients experienced adverse reactions. The overall H. pylori eradication rate was 22.3%. There was no significant difference H. pylori eradication rate depending on the treatment used (28.1%, 21.4% and 15.1% for G1, G2 and G3, p = 0.34). Conclusion: The H. pylori eradication rate was poor regardless of the triple therapy used. It is desirable in the absence of bacteriological data on the primary and secondary resistance levels to optimize the eradication rate advocating the use of quadruple therapy at outset in first-line.

Cite this paper
Doffou, A. , Attia, K. , Bathaix, M. , Bangoura, A. , Kissy-Anzouan, Y. , Kouamé, H. , Mahassadi, K. , N’Da, K. , Kouyaté, M. , Assi, C. and N’dri-Yoman, A. (2015) The Helicobacter pylori Eradication Rate in a High Prevalence Area (West Africa): Three Triple Therapy Comparative Study. Open Journal of Gastroenterology, 5, 200-206. doi: 10.4236/ojgas.2015.512030.
[1]   Moayyedi, P. and Hunt, R.H. (2004) Helicobacter pylori Public Health Implications. Helicobacter, 9, 67-72.

[2]   Suerbaum, S. and Michetti, P. (2002) Helicobacter pylori Infection. New England Journal of Medicine, 347, 1175- 1186.

[3]   Malferthiner, P., Chan, F.K. and Mc Coll, K.E. (2009) Peptic Ulcer Disease. Lancet, 374, 1449-1461.

[4]   Malfertheiner, P., Mégraud, F., O’Morain, C., et al. (2007) Current Concepts in the Management of Helicobacter pylori Infection—The Maastricht III Consensus Report. Gut, 56, 772-781.

[5]   Asaka, M., Kato, M., Takahashi, S., et al., The Japanese Society for Helicobacter Rechearch (2010) Guidelines for the Management of Helicobacter pylori Infection in Japan: 2009 Revised Edition. Helicobacrer, 15, 1-20.

[6]   Chey, W.D. and Wong, B.C.Y. (2007) American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection. American Journal of Gastroenterology, 102, 1808-1825.

[7]   Fock, K.M., Katelaris, P., Sugano, K., et al. (2009) Second Asia-Pacific Consensus Guidelines for Helicobacter pylori Infection. Journal of Gastroenterology and Hepatology, 24, 1587-1600.

[8]   Mégraud, F. (2004) H. pylori Antibiotic Resistance: Prevalence, Importance and Advances in Testing. Gut, 53, 1374- 1384.

[9]   Fischbach, L. and Evans, E.L. (2007) Meta-Analysis: The Effect of Antibiotic Resistance Status on the Efficacy of Triple and Quadruple First-Line Therapies for Helicobacter pylori. Alimentary Pharmacology & Therapeutics, 26, 343-357.

[10]   Fall, F., Diagne, A., Ndiaye, B., et al. (2011) Trithérapie par oméprazole, amoxicilline et clarithromycine dans la maladie ulcéreuse duodénale associée à Helicobacter pylori au Sénégal. Journal African d’Hépato-Gastroentérologie, 5, 28-32.

[11]   Assi, C., Ndah, K.J., Allah-Kouadio, E., et al. (2010) Prévalence de l’infection à Helicobacter pylori et lésions pré-cancéreuses du cancer gastrique chez les patients souffrant d’épigastralgies chroniques. Revue Africaine de Pathologie, 9, 25-31.

[12]   Werme, K., Bisseye, C., Ouedraogo, I., et al. (2015) Diagnostic moléculaire d’helicobacter pylori par PCR chez les patients en consultation gastroentérologique au Centre Médical Saint Camille de Ouagadougou. The Pan African Medical Journal, 21, 123.

[13]   Ramanampamonjy, R.M., Randria, M.J.D., Razafimahefa, S.H., et al. (2007) Séroprévalence de l’infection due à Helicobacter pylori dans un échantillon de population malgache. Bulletin de la Société de pathologie exotique, 100, 57-60.

[14]   Konate, A., Diarra, M., Soucko-Diarra, A., et al. (2007) Gastrites chroniques à l’ère d’Helicobacter pylori au Mali. Acta Endoscopica, 37, 315-320.

[15]   Lamarque, D., Burucoa, C., Courillon-Mallet, A., et al. (2012) Révision des recommandations francaises sur la prise en charge de l’infection par Helicobacter pylori. Hépato-Gastro, 19, 475-502.

[16]   Malfertheiner, P., Megraud, F., O’Morain, C.A., et al. (2012) Management of Helicobacter pylori Infection—The Maastricht IV/Florence Consensus Report. Gut, 61, 646-664.

[17]   Ma, H.-J. and Wang, J.-L. (2013) Quadruple Therapy for Eradication of Helicobacter pylori. World Journal of Gastroenterology, 19, 931-935.

[18]   Pan, K.F., Zhang, L., Gerhard, M., et al. (2016) A Large Randomised Controlled Intervention Trial to Prevent Gastric Cancer by Eradication of Helicobacter pylori in Linqu County, China: Baseline Results and Factors Affecting the Eradication. Gut, 65, 9-18.

[19]   Seyedmajidi, S., Mirsattari, D., Zojaji, H., et al. (2013) Penbactam for Helicobacter pylori Eradication: A Randomised Comparison of Quadruple and Triple Treatment Schedules in an Iranian Population. Arab Journal of Gastroenterology, 14, 1-5.

[20]   (1999) Conférence de consensus sur Helicobacter pylori. Revision des conclusions et recommandations du groupe de travail. Gastroenterologie Clinique et Biologique, 23, C95-C104.

[21]   Lamouliatte, H., Megraud, F., Delchier, J.C., et al. (2003) Second Line Treatment for Failure to Eradicate Helicobacter pylori: A Randomized Trial Comparing Four Treatment Strategies. Alimentary Pharmacology & Therapeutics, 18, 791-797.

[22]   Lind, T., van Zanten, S.V., Unge, P., et al. (1996) Eradication of Helicobacter pylori Using One-Week Triple Therapies Combining Omeprazole with Two Antimicrobials: The MACH I Study. Helicobacter, 1, 138-144.

[23]   Graham, D.Y. and Fischbach, L. (2010) Helicobacter pylori Treatment in the Era of Increasing Antibiotic Resistance. Gut, 59, 1143-1153.

[24]   Kuo, C.H., Hu, H.M., Kuo, F.C., et al. (2009) Efficacy of Levofloxacin-Based Rescue Therapy for Helicobacter pylori Infection after Standard Triple Therapy: A Randomized Controlled Trial. Journal of Antimicrobial Chemotherapy, 63, 1017-1024.

[25]   Tzathas, C., Triantafyllou, K., Mallas, E., et al. (2008) Effect of Helicobacter pylori Eradication and Antisecretory Maintenance Therapy on Peptic Ulcer Recurrence in Cirrhotic Patients: A Prospective, Cohort 2-Year Follow-Up Study. Journal of Clinical Gastroenterology, 42, 744-749.

[26]   Fuccio, L., Minardi, M.E., Zagari, R.M., et al. (2007) Meta-Analysis: Duration of First-Line Proton-Pump Inhibitor Based Triple Therapy for Helicobacter pylori Eradication. Annals of Internal Medicine, 147, 553-562.

[27]   Graham, D.Y., Malaty, H.M., Evans, D.G., et al. (1991) Epidemiology of Helicobacter pylori in an Asymptomatic Population in the United States. Gastroenterology, 100, 1495-1501.

[28]   Replogle, M.L., Glasser, S.L., Hiatt, R.A. and Parsonnet, J. (1995) Biologic Sex as a Risk Factor for Helicobacter pylori Infection in Healthy Young Adults. American Journal of Epidemiology, 142, 856-863.

[29]   Stolte, M. and Meining, A. (2001) The Updated Sydney System: Classification and Grading of Gastritis as the Basis of Diagnosis and Treatment. Canadian Journal of Gastroenterology, 5, 591-598.

[30]   Attia, K.A., N’Dri Yoman, T., Diomandé, M.I., et al. (2001) Aspects cliniques, endoscopiques et histologiques des gastrites chroniques à Helicobacter pylori en Cote d’Ivoire: Etude de 102 patients. Bulletin de la Société de pathologie exotique, 94, 5-8.

[31]   Graham, D.Y. (1998) Antibiotic Resistance in Helicobacter pylori: Implications for Therapy. Gastroenterology, 115, 1272-1277.

[32]   Megraud, F. and Lamouliatte, H. (2003) Review Article: The Treatment of Refractory Helicobacter pylori Infection. Alimentary Pharmacology & Therapeutics, 17, 1333-1343.

[33]   Raymond, J., Lamarque, D., Kalach, N., et al. (2010) High Level of Antimicrobial Resistance in French Helicobacter pylori Isolates. Helicobacter, 15, 21-27.

[34]   Romano, M., Iovene, M.R., Russo, M.I., et al. (2008) Failure of First-Line Eradication Treatment Significantly Increases Prevalence of Antimicrobial-Resistant Helicobacter pylori Clinical Isolates. Journal of Clinical Pathology, 61, 1112-1115.

[35]   Horiki, N., Omata, F., Uemura, M., et al. (2009) Annual Change of Primary Resistance to Clarithromycin among Helicobacter pylori Isolates from1996 through 2008 in Japan. Helicobacter, 14, 86-90.

[36]   Hunt, R.H., Xiao, S.D., Megraud, F., et al. (2011) Helicobacter pylori in Developing Countries. World Gastroenterology Organisation Global Guideline. Journal of Gastrointestinal and Liver Diseases, 20, 299-304.

[37]   Seck, A., Mbengue, M., Gassama-Sow, A., et al. (2009) Antibiotic Susceptibility of Helicobacter pylori Isolates in Dakar, Senegal. The Journal of Infection in Developing Countries, 3, 137-140.

[38]   Lee, J.H., Shin, J.H., Roe, I.H., et al. (2005) Impact of Clarithromycin Resistance on Eradication of Helicobacter pylori in Infected Adults. Antimicrobial Agents and Chemotherapy, 49, 1600-1603.

[39]   De Francesco, V., Margiotta, M., Zullo, A., et al. (2006) Clarithromycin-Resistant Genotypes and Eradication of Helicobacter pylori. Annals of Internal Medicine, 144, 94-100.

[40]   Vaira, D., Zullo, A., Vakil, N., et al. (2007) Sequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori Eradication: A Randomized Trial. Annals of Internal Medicine, 146, 556-563.

[41]   Wu, D.C., Hsu, P.I., Wu, J.Y., et al. (2010) Sequential and Concomitant Therapy with Four Drugs Is Equally Effective for Eradication of H pylori Infection. Clinical Gastroenterology and Hepatology, 8, 36-41.

[42]   Malfertheiner, P., Bazzoli, F., Delchier, J.C., et al. (2011) Helicobacter pylori Eradication with a Capsule Containing Bismuth Subcitrate Potassium, Metronidazole, and Tetracycline Given with Omeprazole versus Clarithromycin-Based Triple Therapy: A Randomised, Open-Label, Non-Inferiority, Phase 3 Trial. The Lancet, 377, 905-913.

[43]   Laine, L., Hunt, R., El-Zimaity, H., et al. (2003) Bismuth-Based Quadruple Therapy Using a Single Capsule of Bismuth Biskalcitrate, Metronidazole, and Tetracycline Given with Omeprazole versus Omeprazole, Amoxicillin, and Clarithromycin for Eradication of Helicobacter pylori in Duodenal Ulcer Patients: A Prospective, Randomized, Multicenter, North American Trial. American Journal of Gastroenterology, 98, 562-567.

[44]   Luther, J., Higgins, P.D., Schoenfeld, P.S., et al. (2010) Empiric Quadruple vs. Triple Therapy for Primary Treatment of Helicobacter pylori Infection: Systematic Review and Meta-Analysis of Efficacy and Tolerability. American Journal of Gastroenterology, 105, 65-73.