Comparative Effect of Proton-Pump Inhibitors on the Success of Triple and Quadruple Therapy forHelicobacter pyloriInfection

Introduction:Suppression of gastric acid secretion with proton-pump inhibitors (PPI) is an integral part of the treatment ofHelicobacter pyloriinfection. Esomeprazole has been shown to be superior to other PPIs when used in the context of triple therapy; however, comparative data for PPI efficacy in quadruple therapy are lacking. Current guidelines recommendH. pylorieradication with quadruple therapy in areas with high clarithromycin resistance.Objective:To determine whether esomeprazole is more effective than other PPIs in the context of quadruple therapy forH. pylorieradication.Methods:We retrospectively identified 25- to 60-year-old subjects with a positive C-13-urea breath test and no prior laboratory or endoscopic test forH. pyloriinfection. Pharmacy dispensation data were retrieved.Results:A total of 7,896 subjects including 2,856 (36.2%) males, aged 40.4 +/- 10.6 years, were identified. Of those, 78.1% received omeprazole, 20.1% received lansoprazole, 1.5% received esomeprazole, and 0.34% received pantoprazole together with antibiotics forH. pylorieradication. Esomeprazole was associated with a greater proportion of successful eradication (85.0 vs. 77.5%, esomeprazole vs. omeprazole, OR 1.64; 95% CI 0.99-2.72;p = 0.05). A nonsignificant trend favored esomeprazole over omeprazole among subjects receiving quadruple therapy (90.0 vs. 82.0%, respectively, OR 1.98; 95% CI 0.68-5.72;p= 0.16). Independent predictors of treatment success included older age and quadruple therapy.Conclusion:Esomeprazole is more beneficial than other PPIs forH. pylorieradication. Studies with larger subgroups are necessary to confirm our findings among subjects receiving quadruple therapy.