Helicobacter pylori in smokers with peripheral vascular disease - Shoud we consider quadruple therapy for eradication routinely?
Infection with Helicobacter pylori is a substantial public health problem that affects 20 to 50% of people in industrialised nations and up to 80% in less-developed countries. H pylori is associated with many gastroduodenal disorders, including peptic ulcer disease, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. In regions with high incidence of gastric carcinoma, eradication of H pylori is advocated to prevent the development of this disease. Further, patients benefit from eradication after endoscopic resection of early gastric carcinoma because it reduces the risk for metachronous gastric neoplasia.
A previous international study, which assessed the efficacy and safety of 10 days of omeprazole with a single (three-in-one) capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) for H pylori eradication in patients with peptic ulcer disease or non-ulcer dyspepsia, reported overall eradication rates greater than 90%.
Quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H pylori, especially since quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy.
Infection with Helicobacter pylori is a substantial public health problem that affects 20 to 50% of people in industrialised nations and up to 80% in less-developed countries. H pylori is associated with many gastroduodenal disorders, including peptic ulcer disease, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. In regions with high incidence of gastric carcinoma, eradication of H pylori is advocated to prevent the development of this disease. Further, patients benefit from eradication after endoscopic resection of early gastric carcinoma because it reduces the risk for metachronous gastric neoplasia.
A previous international study, which assessed the efficacy and safety of 10 days of omeprazole with a single (three-in-one) capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) for H pylori eradication in patients with peptic ulcer disease or non-ulcer dyspepsia, reported overall eradication rates greater than 90%.
Quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H pylori, especially since quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy.
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