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Efficacy of serology driven "test and treat strategy" for eradication of H. pylori in patients with rheumatic disease in the Netherlands.

Author(s): de Leest HT, Steen KS, Lems WF, van de Laar MA, Huisman AM, Kadir SW, Houben HH, Kostense PJ, Kuipers EJ, Dijkmans BA, Debets-Ossenkopp YJ

Affiliation(s): Department of Rheumatology, VU University Medical Center Amsterdam, P.O. Box 7057, Amsterdam, The Netherlands. marleen.deleest@planet.nl

Publication date & source: 2011-07, Eur J Clin Microbiol Infect Dis., 30(7):903-8. Epub 2011 Feb 4.

Publication type: Randomized Controlled Trial

The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000-2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9-20%) and in the placebo group 79% (123/155, 95% CI 72-85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18-63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline.

Page last updated: 2011-12-09

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