Bong Eun Lee1, Joon Sung Kim2, Byung-Wook Kim2, Jie-Hyun Kim3, Jin Il Kim4, Jun-Won Chung5, Seong Woo Jeon6, Jeong Hoon Lee7, Ji Hyun Kim8, Nayoung Kim9, Ju Yup Lee10, Seung Young Seo11, Seon-Young Park12, Sung Eun Kim13, Moon Kyung Joo14, Hyun Joo Song15, Ki Bae Kim16, Chang Seok Bang17, Hyun Jin Kim18. 1. Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea. 2. Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea. 3. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 4. Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Yeongdeungpo-gu, South Korea. 5. Department of Internal Medicine, Gachon University College of Medicine, Incheon, South Korea. 6. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea. 7. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 8. Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea. 9. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea. 10. Department of Internal Medicine, Keimyung University School of Medicine Dongsan Medical Center, Daegu, South Korea. 11. Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, South Korea. 12. Department of Internal Medicine, Chonnam National University School of Medicine, Gwangju, South Korea. 13. Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea. 14. Department of Internal Medicine, Korea University College of Medicine Guro Hospital, Seoul, South Korea. 15. Department of Internal Medicine, Jeju National University School of Medicine, Jeju, South Korea. 16. Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea. 17. Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea. 18. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
Abstract
BACKGROUND: Eradication rate of standard triple therapy for H. pylori has declined to unacceptable level, and alternative regimens such as concomitant and sequential therapy have been introduced. We aimed to assess the consistency of eradication rates of concomitant and sequential therapies as for the first-line H. pylori eradication in Korea. METHODS: A nationwide multicenter retrospective study was conducted including 18 medical centers from January 2008 to December 2017. We included 3,800 adults who had test to confirm H. pylori eradication within 1 year after concomitant or sequential therapy. RESULTS: Concomitant and sequential therapy were prescribed for 2508 and 1292 patients, respectively. The overall eradication rate of concomitant therapy was significantly higher than that of sequential therapy (91.8% vs. 86.1%, p < .001). In time trend analysis, the eradication rates of concomitant therapy were 90.2%, 88.2%, 92.1%, 94.3%, 91.1%, and 93.4% for each year from 2012 to 2017 with an increasing trend (p = .0146), while those of ST showed no significant trend (p = .0873). Among 263 patients with second-line therapy, bismuth quadruple therapy showed significantly higher eradication rate than quinolone-based triple therapy (73.9% vs. 51.5% in ITT analysis, p = .001; 82.7% vs. 63.0% in PP analysis, p = .002). CONCLUSION: Concomitant therapy is the best regimen for the first-line H. pylori eradication showing consistently higher eradication rate with an increasing trend for the last 10 years in Korea. Bismuth quadruple therapy should be considered for second-line therapy after eradication failure using non-bismuth quadruple therapy.
BACKGROUND: Eradication rate of standard triple therapy for H. pylori has declined to unacceptable level, and alternative regimens such as concomitant and sequential therapy have been introduced. We aimed to assess the consistency of eradication rates of concomitant and sequential therapies as for the first-line H. pylori eradication in Korea. METHODS: A nationwide multicenter retrospective study was conducted including 18 medical centers from January 2008 to December 2017. We included 3,800 adults who had test to confirm H. pylori eradication within 1 year after concomitant or sequential therapy. RESULTS: Concomitant and sequential therapy were prescribed for 2508 and 1292 patients, respectively. The overall eradication rate of concomitant therapy was significantly higher than that of sequential therapy (91.8% vs. 86.1%, p < .001). In time trend analysis, the eradication rates of concomitant therapy were 90.2%, 88.2%, 92.1%, 94.3%, 91.1%, and 93.4% for each year from 2012 to 2017 with an increasing trend (p = .0146), while those of ST showed no significant trend (p = .0873). Among 263 patients with second-line therapy, bismuth quadruple therapy showed significantly higher eradication rate than quinolone-based triple therapy (73.9% vs. 51.5% in ITT analysis, p = .001; 82.7% vs. 63.0% in PP analysis, p = .002). CONCLUSION: Concomitant therapy is the best regimen for the first-line H. pylori eradication showing consistently higher eradication rate with an increasing trend for the last 10 years in Korea. Bismuth quadruple therapy should be considered for second-line therapy after eradication failure using non-bismuth quadruple therapy.