Date of Award

7-1-2010

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

Department

Internal Medicine (East Africa)

Abstract

Background: Helicobacter is associated with a number of important upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor -based triple therapies are considered the standard regimens for Helicobacter pylori eradication, but the optimal duration of these regimens is still controversial. Local studies are required to evaluate the H. pylori eradication rates in a country for adequate eradication to prevent H. pylori infection and complications

Objectives: The main objective of this study was to compare 7 day and 14 day regimens and determine the optimum duration of triple therapy for H. pylori eradication.

Methods: A prospective randomised comparative trial of 7 and 14 day H. pylori eradication triple therapy at the Aga Khan University Hospital Nairobi. One hundred and twenty patients with dyspepsia and H. pylori infection were randomized to receive esomeprazole, amoxicillin and clarithromycin for either 7 days (EAC 7) or 14 days (EAC 14). Compliance and side affects were assessed two weeks after start of therapy and H. pylori eradication was assessed by H. pylori stool antigen done four weeks after treatment.

Results: Both the intention-to-treat (ITT; n = 120) and per protocol (PP; n = 97) analyses showed no significant differences between the eradication rates of EAC 7 (ITT 76.7%; PP 92%) and EAC 14 (ITT 73.3%; PP 93.6%; ITT p = 0.67; PP p = 0.76). Poor compliance was reported in only one patient who was in EAC 14 group. Incidences of adverse events were comparable.

Conclusion: 1-week and 2-week triple treatments for H. pylori eradication are similar in terms of efficacy, safety and patient compliance.

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