The efficacies of esomeprazole- versus pantoprazole-based reverse hybrid therapy for Helicobacter pylori eradication

Reverse hybrid therapy, modified from the hybrid regimen by changing the sequence of drug administration, achieves a high eradication rate for Helicobacter pylori and is superior to standard triple therapy. Currently, the impacts of different proton pump inhibitors on the efficacy of this novel therapy remain unanswered. This study was conducted to compare the efficacies of esomeprazole- and pantoprazole-based reverse hybrid therapies for H. pylori eradication. From August 2015 to May 2016, H. pylori-infected patients receiving either a 14-day esomeprazole- or a pantoprazole-based reverse hybrid therapy (esomeprazole or pantoprazole 40mg and amoxicillin 1g twice-daily for 14 days, plus clarithromycin 500mg and metronidazole 500mg twice-daily for the initial seven days) for H. pylori eradication were included in the retrospective study. All the patients underwent a follow-up endoscopy with a rapid urease test and histological examination or a urea breath test at eight weeks after the end of anti-H. pylori therapy to assess H. pylori status. To determine the independent factors affecting the treatment response, 12 clinical and endoscopic parameters were analyzed by multivariate analysis. In all, 123 H. pylori-infected outpatients were included for this study. Among them, 62 received the esomeprazole-based regimen and 61 received the pantoprazole-based regimen. Intention-to-treat (ITT) analysis demonstrated no differences in eradication rate between esomeprazole- and pantoprazole-based groups (90% vs 97%; P=0.273). Modified ITT (90% vs 98%) and per-protocol analysis (92% vs 98%) yielded similar results (P=0.115 and 0.116, respectively). Both groups had comparable frequencies of adverse events (16% vs 21%; P=0.779) and drug compliance (98% and 93%; P=0.207). The eradication rates were significantly related to increased body fat percentage (P=0.002) and the presence of diabetes (P=0.033). Multivariate analysis disclosed an increased body fat percentage (odds ratio: 0.072, 95% confidence interval: 0.008-0.623), which was the only independent predictor of treatment failure. Esomeprazole- and pantoprazole-based reverse hybrid regimens have comparable anti-H. pylori efficacy and both achieve an eradication rate more than 90%. Increased body fat percentage is a clinical factor predicting eradication failure of reverse hybrid therapy.