The efficacy of triple therapy in eradication of H. pylori in Sudanese patients with gastroduodenal inflammation

Abstract

H. Pylori is a spiral-shaped gram negative bacterium. The organisms shape and flagella allow penetration of and movement through the gastric mucous layer. H. Pylori primarily colonizes the stomach and is well adapted to survive in this otherwise hostile environment. The organism lives within or beneath the gastric mucous layer, somewhat protected from stomach acid, and generally does not invade the epithelial cells. Infection with H. Pylori produces an active chronic gastritis. Patients with antral gastritis are more likely to develop subsequent duodenal ulcers, whereas patients with pangastritis are at risk of developing gastric ulcers or adenocarcinoma. The aim of this study is to evaluate the efficacy of triple therapy in the form of Lansoprazole (Lansazol(R)), Amoxicillin (Amixillin Forte(R)) and Metronidazole (Aminidazol(R)) in the eradication of H. Pylori In Sudanese patients with gastroduodenal inflammation in the form of duodenal ulcer, gstritis and duodenitis. This study is a prospective drug trial carried out in the period from April 2002 to October 2002. Thirty five patients with gatroduodenal inflammation confirmed by endoscopy in the form of duodenal ulcer (31%), gastritis (31%), duodenitis(29%) and gastritis + duodenitis (9%),who were positive for H. Pylori, were included in the study. Antral biopsies were taken and rapid urease test was used to test for the organism. All positive patients for H. Pylori were interviewed via a questionnaire. They were supplied with Amoxicillin (Amixillin Forte(R)) 1 gm b.d for one week and Metronidazole (Aminidazol(R)) 1 gm b.d for one week and Lansoprazole (Lansazol(R)) 30 mg o.d for 3 weeks. The patients were followed up 2 weeks after commencement of treatment for improvement in symptoms, compliance and reporting of side effects. They were re-endoscoped 4 weeks after completion of treatment, healing of gastroduodenal inflammation was assessed and 2 biopsies were taken one from the antrum and the other from the body of the stomach. The biopsies were re-tested for H. Pylori using rapid urease test. Thirty patients (86%) came back for follow up. Compliance to treatment was 86%. Side effects to drugs, especially to metronidazole were reported. The side effects were mild and no patient discontinued therapy because of them. 93% of patients reported improvement in symptoms. The overall complete healing rate was 73%. The complete healing rate in patients with duodenal ulcers was 100%. Eradication of H. Pylori was achieved in 67% of patients. From this study it has been shown that in Sudanese patients the triple therapy composed of the combination of Lansoprazole, Amoxicillin and Metronidazole is effective in eradication of H. Pylori.