Helicobacter pylori eradication therapy in an area of southeastern Brazil: a cohort study

Authors

DOI:

https://doi.org/10.5902/2179460X43687

Keywords:

Helicobacter pylori, Therapy, Retrospective cohort, Epidemiology, Brazil

Abstract

The Second and Third Brazilian Consensuses on Helicobacter pylori indicate the combination of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin as the first-line therapy for eradicating this pathogen, but this regimen has been criticized for the recent decrease in its efficacy in several parts of the world. There are little data on the efficacy of H. pylori eradication regimens in the interior of Brazil. OBJECTIVE: To describe the treatments prescribed for the eradication of H. pylori with their respective efficacy rates in a cohort living in the Zona da Mata of Minas Gerais. DESIGN: A retrospective cohort study with treatment-naïve patients known to have gastric infection by H. pylori, residents of the Zona da Mata of Minas Gerais, submitted to eradication therapy of this pathogen in the periods 2007 to 2011, and 2013 to 2016. The H. pylori eradication rates obtained with the prescribed treatments were evaluated as outcomes. RESULTS: We analyzed 5010 medical records from a single health service, with 264 prescriptions for initial treatments to eradicate H. pylori using PPI associated with amoxicillin and clarithromycin for 7 days in 243 cases (88.25%). The overall efficacy rate of this regimen was 54.07%, with no differences in efficacy between the two periods analyzed (2007 to 2011: 54.55%, 2013 to 2016: 53.65, p = 0.892) There were no differences in efficacy according to the choice of PPI: Omeprazole-AC7: 52.55%, OR = 1 (72 successes out of 137); Lansoprazole-AC7: 44.18%. OR = 1.399, p = 0.28 (38 out of 86); and Pantoprazole-AC-7: 60%, OR = 0.739, p = 0.701 (12 out of 20). CONCLUSIONS: In this cohort, the efficacy rates of the regimens recommended by the Brazilian Consensus on Helicobacter pylori were lower than those previously described in the Brazilian literature, suggesting the need for a revision of the official recommendations.

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Author Biographies

Alessandro Lisboa da Silva, Departamento de Medicina e Enfermagem - DEM. Universidade Federal de Viçosa - UFV.

Mestre em Ciências da Saúde, programa de Pós-graduação em Ciências da Saúde, Departamento de Medicina e Enfermagem - DEM. Universidade Federal de Viçosa - UFV. 

Rodrigo Siqueira Batista, Departamento de Enfermagem e Medicina (DEM-UFV).

Professor da Universidade Federal de Viçosa. Departamento de Enfermagem e Medicina (DEM-UFV).

Paulo Sérgio Balbino Miguel, Departamento de Enfermagem e Medicina (DEM-UFV).

Doutor e mestre em Microbiologia, Universidade Federal de Viçosa.

Tiago Ricardo Moreira, Departamento de Enfermagem e Medicina (DEM-UFV).

Professor da Universidade Federal de Viçosa. Departamento de Enfermagem e Medicina (DEM-UFV).

Andreia Patrícia Gomes, Departamento de Enfermagem e Medicina (DEM-UFV).

Professora da Universidade Federal de Viçosa. Departamento de Enfermagem e Medicina (DEM-UFV).

References

BELLELIS P, SAMANO EST, NUNES RC, RIBEIRO L DE M, CHEHTER EZ, CATAPANI WR. Efficacy of a triple therapy for Helicobacter pylori eradication in a well-developed urban area in Brazil. Sao Paulo. Med. J. [Internet]. 2004;122(2):73–5. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&nrm=iso&lng=pt&tlng=pt&pid=S1516-31802004000200009

BERTOLI NETO JL, LOURENCO LG, BERTOLI CF, ULBRICH FS, SABBI AR, BUENO AG. Evaluation of the efficacy of triple therapy regimen for Helicobacter pylori eradication in gastrectomized patients with gastric adenocarcinoma. Gastric. Cancer. 2006;9(4):291–4.

COELHO LGV, MAGUINILK I, ZATERKA S, PARENTE JM, PASSOS M DO CF, MORAES-FILHO JPP. 3rd Brazilian Consensus on Helicobacter pylori. Arq. Gastroenterol. [Internet]. 2013;50(2):81–96. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032013000200081&lng=en&tlng=en

COELHO LGV, ZATERKA S. II Consenso Brasileiro sobre Helicobacter pylori. Arq. Gastroenterol. 2005;42(2):128–32.

COELHO LGV, ALVES DE MATTOS Â, FERNANDO C, FRANCISCONI M, DE L, CASTRO P, et al. Eficácia do regime terapêutico empregando a associação de pantoprazol, claritromicina e amoxicilina, durante uma semana, na erradicação do Helicobacter pylori em pacientes com úlcera péptica. Arq. Gastroenterol. [Internet]. 2004 [citado 12 de outubro de 2017]; Available from: http://www.scielo.br/pdf/ag/v41n1/v41n1a14.pdf

COELHO LGV, MARINHO JR, GENTA R, RIBEIRO LT, PASSOS M DO CF, ZATERKA S, et al. Ivth Brazilian consensus conference on Helicobacter pylori Infection. Arq. Gastroenterol. 2018;55(2):97–121.

ECCLISSATO C, MARCHIORETTO MAM, MENDONCA S, GODOY APO, GUERSONI RA, DEGUER M, et al. Increased primary resistance to recommended antibiotics negatively affects Helicobacter pylori eradication. Helicobacter. 2002;7(1):53–9.

EISIG JN, NAVARRO-RODRIGUEZ T, TEIXEIRA ACS, SILVA FM, MATTAR R, CHINZON D, et al. Standard triple therapy versus sequential therapy in Helicobacter pylori eradication: A double-blind, randomized, and controlled trial. Gastroenterol. Res. Pract. [Internet]. 2015;2015:1–5. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434224/?tool=pubmed

FELGA G, SILVA FM, BARBUTI RC, NAVARRO-RODRIGUEZ TT, ZATERKA S, EISIG JN. Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients. J. Infect. Dev. Ctries. [Internet]. 2010;4(11):712–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21252448

FORD AC, FORMAN D, HUNT R, YUAN Y, MOAYYEDI P. Helicobacter pylori eradication for the prevention of gastric neoplasia. In: MOAYYEDI P, organizador. Cochrane database of systematic reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2015. Available from: http://doi.wiley.com/10.1002/14651858.CD005583.pub2

GRAHAM DY, DORE MP. Helicobacter pylori therapy: a paradigm shift. Expert. Rev. Anti Infect. Ther. [Internet]. 2016;7210(April):14787210.2016.1178065. Available from: http://www.tandfonline.com/doi/full/10.1080/14787210.2016.1178065

LEE Y-C, CHIANG T-H, CHOU C-K, TU Y-K, LIAO W-C, WU M-S, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: A systematic review and meta-analysis. Gastroenterology [Internet]. 2016;150(5):1113–1124.e5. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016508516001207

MALFERTHEINER P, MÉGRAUD F, O’MORAIN C, HUNGIN AP, JONES R, AXON A, et al. Current concepts in the management of Helicobacter pylori infection--the Maastricht 2-2000 Consensus Report. Aliment. Pharmacol. Ther. [Internet]. 2002;16(2):167–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11860399

MALFERTHEINER P, MEGRAUD F, O’MORAIN C, BAZZOLI F, EL-OMAR E, GRAHAM D, et al. Current concepts in the management of Helicobacter pylori infection: The Maastricht III Consensus Report. Gut. [Internet]. 2007;56(6):772–81. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1954853&tool=pmcentrez&rendertype=abstract

MALFERTHEINER P, MÉGRAUD F, O’MORAIN CA, ATHERTON J, AXON ATR, BAZZOLI F, et al. Management of Helicobacter pylori infection - The Maastricht {IV/} Florence Consensus Report. Gut. 2012;61(5):646–64.

MALFERTHEINER P, MEGRAUD F, O’MORAIN CA, GISBERT JP, KUIPERS EJ, AXON AT, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report. Gut [Internet]. 2017;66(1):6–30. Available from: http://gut.bmj.com/lookup/doi/10.1136/gutjnl-2016-312288

MAZZOLENI LE, SANDER GB, FRANCESCONI CF MAZZOLENI F, UCHOA DM, DE BONA LR, et al. Helicobacter pylori eradication in functional dyspepsia: HEROES trial. Arch. Intern. Med. [Internet]. 2011;171(21):1929–36. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinternmed.2011.533

McNICHOLL AG, LINARES PM, NYSSEN OP, CALVET X, GISBERT JP. Meta-analysis: Esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection. Aliment. Pharmacol. Ther. 2012;36(5):414–25.

NABINGER DD, MAZZOLENI LE, SANDER GB, MAZZOLENI F, OSÓRIO MC, KLEIN MG, et al. Influence of CYP2C19 on Helicobacter pylori eradication in Brazilian patients with functional dyspepsia. Genet. Mol. Res. Genet. Mol. Res. [Internet]. 2016 [citado 18 de abril de 2018];15(153). Available from: http://www.funpecrp.com.br/gmr/year2016/vol15-3/pdf/gmr8734.pdf

SANCHES BS, MARTINS GM, LIMA K, COTA B, MORETZSOHN LD, RIBEIRO LT, et al. Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil: A national survey Observational Study. World. J. Gastroenterol. 2016;22(33):7587–94.

SCHEFFER, M; BIANCARELLI, A; CASSENOTE A, organizador. Demografia médica no Brasil - volume 1: dados gerais e descrições de desigualdades [Internet]. Vol. 1. São Paulo: Conselho, Conselho Regional de Medicina do Estado de São Paulo e Medicina, Federal de; 2011. Available from: http://www.flip3d.com.br/web/temp_site/edicao-1415db70fe9ddb119e23e9b2808cde38.pdf

SUGANO K, TACK J, KUIPERS EJ, GRAHAM DY, EL-OMAR EM, MIURA S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut [Internet]. 2015;1–15. Available from: http://gut.bmj.com/lookup/doi/10.1136/gutjnl-2015-309252

TANG HL, LI Y, HU YF, XIE HG, ZHAI SD. Effects of CYP2C19 loss-of-function variants on the eradication of H. pylori infection in patients treated with proton pump inhibitor-based triple therapy regimens: A meta-analysis of randomized clinical trials. PLoS One. 2013;8(4):e62162

THUNG I, ARAMIN H, VAVINSKAYA V, GUPTA S, PARK JY, CROWE SE, et al. Review article: The global emergence of Helicobacter pylori antibiotic resistance. Aliment. Pharmacol. Ther. 2016;43(4):514–33.

ZAMANI M, EBRAHIMTABAR F, ZAMANI V, MILLER WH, ALIZADEH-NAVAEI R, SHOKRI-SHIRVANI J, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment. Pharmacol. Ther. [Internet]. 2018;47(7):868–76. Available from: http://doi.wiley.com/10.1111/apt.14561.

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Published

2021-05-18 — Updated on 2022-04-06

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How to Cite

Silva, A. L. da, Batista, R. S., Miguel, P. S. B., Moreira, T. R., & Gomes, A. P. (2022). Helicobacter pylori eradication therapy in an area of southeastern Brazil: a cohort study. Ciência E Natura, 43, e18. https://doi.org/10.5902/2179460X43687 (Original work published May 18, 2021)

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