Improved Eradication Rate of Standard Triple Therapy by Adding Bismuth and Probiotic Supplement for Helicobacter pylori Treatment in Thailand

Background: Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcerdisease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However,standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand.This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy forH. pylori eradication. Materials and
Methods: In this prospective single center study, H. pylori infected gastritispatients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo.Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycinMR once daily and 1,048mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacteriumlactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt withoutprobiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication wasdefined as a negative 13C-urea breath test at least 2 weeks after completion of treatment.
Results: One hundredsubjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibilitytests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%,49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantlylower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%;p=0.04).
Conclusions: The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent curerate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19genotype. Adding a probiotic also reduced treatment-related adverse events.