TY - JOUR ID - 88743 TI - High Effective of 14-Day High-Dose PPI- Bismuth-Containing Quadruple Therapy with Probiotics Supplement for Helicobacter Pylori Eradication: A Double Blinded-Randomized Placebo-Controlled Study JO - Asian Pacific Journal of Cancer Prevention JA - APJCP LA - en SN - 1513-7368 AU - Poonyam, Piyakorn AU - Chotivitayatarakorn, Peranart AU - Vilaichone, Ratha-Korn AD - Gastroenterology Unit, Thammasat University Hospital, Pathumthani, Thailand. Y1 - 2019 PY - 2019 VL - 20 IS - 9 SP - 2859 EP - 2864 KW - High-dose PPI KW - quadruple therapy KW - probiotics supplement KW - Helicobacter pylori DO - 10.31557/APJCP.2019.20.9.2859 N2 - Background: Helicobacter pylori (H. pylori) infection is important risk factors for chronic gastritis, peptic ulcer andgastric cancer. Bismuth-containing quadruple therapy has recently been the first-line regimen recommended in manyEuropean countries but has limited efficacy in ASEAN especially Thailand. This study was aim to evaluate efficacy ofhigh dose PPI Bismuth-containing quadruple therapy with probiotics supplement for H. pylori eradication. Methods:In this double-blind randomized placebo-controlled study, H. pylori infected patients were randomized to receive 7-or14-day high dose PPI- bismuth-containing quadruple therapy with or without probiotics supplement. Probiotic was37.5 mg Lactobacillus reuteri (Biogaia®) in tablet twice daily. CYP2C19 genotyping and antibiotic susceptibility testswere also done. H. pylori eradication was defined as a negative 13C-urea breath test at least 4 weeks after treatment.Results: 100 subjects were enrolled (72 females, 28 males, mean age=54 years). Antibiotic resistance was 15.6% forclarithromycin, 34.1% for metronidazole. CYP2C19 genotyping was performed in both group and revealed 13%, 50% and37% for poor, intermediate and rapid metabolizers, respectively. Overall eradication rates of 7-day and 14-day regimenswith probiotic were 68% and 96%; P value=0.027. The eradication rate for all patients with poor and rapid metabolizerswere 100% with 14-day regimen. 14-day regimen with probiotics can provide 100% eradication with clarithromycinresistance, metronidazole resistance or dual clarithromycin and metronidazole resistance group. Furthermore, theincidence of nausea and vomiting, abdominal discomfort, and bitter taste were significantly lower in patients withprobiotics group compared with placebo (6%vs.26%, P=0.002,OR=0.126,95% CI=0.03-0.53; 4%vs.18.0%, P=0.017,OR= 0.155,95% CI=0.03-0.81 and 4%vs.26%, P= 0.001,OR= 0.08, 95%CI= 0.016-0.41, respectively). Conclusions:The 14-day high dose PPI- bismuth-containing quadruple therapy with probiotic can provide an excellent cure rate forH. pylori infection as first line treatment irrespective of CYP2C19 and antibiotic resistance pattern. Adding probioticalso significantly reduced treatment-related adverse events and improve the patients’ compliance. UR - https://journal.waocp.org/article_88743.html L1 - https://journal.waocp.org/article_88743_6264df018ebedbb8d4e095dc77dd0b44.pdf ER -