The impact of bismuth addition to sequential treatment on Helicobacter pylori eradication: A pilot study

Authors

  • Sebahat Basyigit Kecioren Research and Training Hospital, Department of Gastroenterology, Ankara, Turkey
  • Ayse Kefeli
  • Ferdane Sapmaz
  • Abdullah Ozgur Yeniova
  • Zeliha Asilturk https://orcid.org/0000-0003-1165-3982
  • Murat Hokkaomeroglu
  • Metin Uzman
  • Yasar Nazligul

DOI:

https://doi.org/10.17305/bjbms.2015.573

Keywords:

Amoxicillin, metronidazole, clarithromycin, antibiotic resistance, Helicobacter pylori

Abstract

The success of the current anti-Helicobacter pylori (H. pylori) treatment protocols is reported to decrease by years, and research is needed to strengthen the H. pylori eradication treatment. Sequential treatment (ST), one of the treatment modalities for H. pylori eradication, includes amoxicillin 1 gr b.i.d and proton pump inhibitor b.i.d for first 5 days and then includes clarithromycin 500 mg b.i.d, metronidazole 500 mg b.i.d and a proton pump inhibitor b.i.d for remaining 5 days. In this study, we investigated efficacy and tolerability of bismuth addition in to ST. We included patients that underwent upper gastrointestinal endoscopy in which H. pylori infection was diagnosed by histological examination of antral and corporal gastric mucosa biopsy. Participants were randomly administered ST or bismuth containing ST (BST) protocols for the first-line H. pylori eradication therapy. Participants have been tested by urea breath test for eradication success 6 weeks after the completion of treatment. One hundred and fifty patients (93 female, 57 male) were enrolled. There were no significant differences in eradication rates for both intention to treat population (70.2%, 95% confidence interval [CI]: 66.3-74.1% vs. 71.8%, 95% CI: 61.8-81.7%, for ST and BST, respectively, p > 0.05) and per protocol population (74.6%, 95% CI: 63.2-85.8% vs. 73.7%, 95% CI: 63.9-83.5% for ST and BST, respectively, p > 0.05). Despite the undeniable effect of bismuth, there may be several possible reasons of unsatisfactory eradication success. Drug administration time, coadministration of other drugs, possible H. pylori resistance to bismuth may affect the eradication success. The addition of bismuth subcitrate to ST regimen does not provide significant increase in eradication rates.

References

Graham DY, Lu H, Yamaoka Y. Therapy for Helicobacter pylori infection can be improved: Sequential therapy and beyond. Drugs 2008; 68(6):725-36. http://dx.doi.org/10.2165/00003495-200868060-00001.

Zullo A, Vaira D, Vakil N, Hassan C, Gatta L, Ricci C, et al. High eradication rates of Helicobacter pylori with a new sequential treatment. Aliment Pharmacol Ther 2003; 17(5):719-26. http://dx.doi.org/10.1046/j.1365-2036.2003.01461.x.

Greenberg ER, Anderson GL, Morgan DR, Torres J, Chey WD, Bravo LE, et al. 14-day triple, 5-day concomitant, and 10-day sequential therapies for Helicobacter pylori infection in seven Latin American sites: A randomised trial. Lancet 2011; 378(9790):507-14. http://dx.doi.org/10.1016/S0140-6736(11)60825-8.

Chung JW, Jung YK, Kim YJ, Kwon KA, Kim JH, Lee JJ, et al. Ten-day sequential versus triple therapy for Helicobacter pylori eradication: A prospective, open-label, randomized trial. J Gastroenterol Hepatol 2012; 27(11):1675-80. http://dx.doi.org/10.1111/j.1440-1746.2012.07249.x.

Kim JS, Kim BW, Ham JH, Park HW, Kim YK, Lee MY, et al. Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic review and meta-analysis. Gut Liver 2013; 7(5):546-51. http://dx.doi.org/10.5009/gnl.2013.7.5.546.

Kang KK, Lee DH, Oh DH, Yoon H, Shin CM, Park YS, et al. Helicobacter pylori eradication with moxifloxacin-containing therapy following failed first-line therapies in South Korea. World J Gastroenterol 2014; 20(22):6932-8. http://dx.doi.org/10.3748/wjg.v20.i22.6932.

Ciccaglione AF, Cellini L, Grossi L, Marzio L. Quadruple therapy with moxifloxacin and bismuth for first-line treatment of Helicobacter pylori. World J Gastroenterol 2012; 18:4386-90. http://dx.doi.org/10.3748/wjg.v18.i32.4386.

Ergül B, Dogan Z, Sarikaya M, Filik L. The efficacy of two-week quadruple first-line therapy with bismuth, lansoprazole, amoxicillin, clarithromycin on Helicobacter pylori eradication: A prospective study. Helicobacter 2013; 18(6):454-8. http://dx.doi.org/10.1111/hel.12086.

Xu MH, Zhang GY, Li CJ. Efficacy of bismuth-based quadruple therapy as first-line treatment for Helicobacter pylori infection. Zhejiang Da Xue Xue Bao Yi Xue Ban 2011; 40:327-31.

McLoughlin R, Racz I, Buckley M, O'Connor HJ, O'Morain C. Therapy of Helicobacter pylori. Helicobacter 2004; 9 Suppl 1:42-8. http://dx.doi.org/10.1111/j.1083-4389.2004.00251.x.

Tanimura H, Kawano S, Kubo M, Abe T, Goto M, Tanabe J, et al. Does Helicobacter pylori eradication depend on the period of amoxicillin treatment? A retrospective study. J Gastroenterol 1998; 33(1):23-6. http://dx.doi.org/10.1007/PL00009962.

Bakir OS, Ozakin C, Keskin M. Antibiotic resistance rates of Helicobacter pylori isolates and the comparison of E-test and fluorescent in situ hybridization methods for the detection of clarithromycin resistants trains. Mikrobiyol Bul 2009; 43(2):227-34.

Aygul K. The isolation of Helicobacter pylori from antral biopsy specimens and antibiotic susceptibility. Turkey, Van YuzuncuYil University Pub; 2006.

Cagdas U, Otag F, Tezcan S, Sezgin O, Aslan G, Emekdas G. Detection of Helicobacter pylori and antimicrobial resistance in gastric biopsy specimens. Mikrobiyol Bul 2012; 46(3):398-409.

Kadayifci A, Uygun A, Kilciler G, Kantarcioglu M, Kara M, Ozcan A, et al. Low efficacy of clarithromycin including sequential regimens for Helicobacter pylori infection. Helicobacter 2012; 17(2):121-6. http://dx.doi.org/10.1111/j.1523-5378.2011.00924.x.

Dolapcioglu C, Koc-Yesiltoprak A, Ahishali E, Kural A, Dolapcioglu H, Soylu A, et al. Sequential therapy versus standard triple therapy in Helicobacter pylori eradication in a high clarithromycin resistance setting. Int J Clin Exp Med 2014; 7(8):2324-8.

Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection – The maastricht IV/ florence consensus report. Gut 2012; 61(5):646-64. http://dx.doi.org/10.1136/gutjnl-2012-302084.

Onal IK, Gokcan H, Benzer E, Bilir G, Oztas E. What is the impact of Helicobacter pylori density on the success of eradication therapy: A clinico-histopathological study. Clin Res Hepatol Gastroenterol 2013; 37(6):642-6. http://dx.doi.org/10.1016/j.clinre.2013.05.005.

Songür Y, Senol A, Balkarli A, Bastürk A, Cerçi S. Triple or quadruple tetracycline-based therapies versus standard triple treatment for Helicobacter pylori treatment. Am J Med Sci 2009; 338(1):50-3. http://dx.doi.org/10.1097/MAJ.0b013e31819c7320.

Köksal AS, Parlak E, Filik L, Yolcu OF, Odemis B, Ulker A, et al. Ranitidine bismuth citrate-based triple therapies as a second-line therapy for Helicobacter pylori in Turkish patients. J Gastroenterol Hepatol 2005; 20(4):637-42. http://dx.doi.org/10.1111/j.1440-1746.2005.03801.x.

Avsar E, Tiftikçi A, Poturoglu S, Erzin Y, Kocakaya O, Dinçer D, et al. A multicenter, randomized, prospective study of 14-day ranitidine bismuth citrate- vs. lansoprazole-based triple therapy for the eradication of Helicobacter pylori in dyspeptic patients. Turk J Gastroenterol 2013; 24(4):316-21. http://dx.doi.org/10.4318/tjg.2013.0509

Goodwin CS, Marshall BJ, Blincow ED, Wilson DH, Blackbourn S, Phillips M. Prevention of nitroimidazole resistance in Campylobacter pylori by coadministration of colloidal bismuth subcitrate: Clinical and in vitro studies. J Clin Pathol 1988; 41(2):207-10. http://dx.doi.org/10.1136/jcp.41.2.207.

Cheng H, Jiang LI. Vitro activity of bismuth potassium citrate against clinical isolates of antibiotic-resistant Helicobacter pylori. Chin J Gastroenterol Hepatol 2008; 7:1-5.

Chiba N, Rao BV, Rademaker JW, Hunt RH. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol 1992; 87(12):1716-27.

Chiba N. Effects of in vitro antibiotic resistance on treatment: Bismuth-containing regimens. Can J Gastroenterol 2000; 14(10):885-9.

Paradies HH. Bismuth — from the element to the tablet: The general chemistry of bismuth with relevance to pharmacy and medicine. In: Helicobacter Pylori, Gastritis and Peptic Ulcer. Berlin: Springer Berlin Heidelberg; 1990. http://dx.doi.org/10.1007/978-3-642-75315-2_60.

Keogan DM, Griffith DM. Current and potential applications of bismuth-based drugs. Molecules 2014; 19(9):15258-97. http://dx.doi.org/10.3390/molecules190915258.

Stratton CW, Warner RR, Coudron PE, Lilly NA. Bismuth-mediated disruption of the glycocalyx-cell wall of Helicobacter pylori: Ultrastructural evidence for a mechanism of action for bismuth salts. J Antimicrob Chemother 1999; 43(5):659-66. http://dx.doi.org/10.1093/jac/43.5.659.

Stoltenberg M, Martiny M, Sørensen K, Rungby J, Krogfelt KA. Histochemical tracing of bismuth in Helicobacter pylori after in vitro exposure to bismuth citrate. Scand J Gastroenterol 2001; 36(2):144-8. http://dx.doi.org/10.1080/003655201750065889

Salvador JA, Figueiredo SA, Pinto RM, Silvestre SM. Bismuth compounds in medicinal chemistry. Future Med Chem 2012; 4(11):1495-523. http://dx.doi.org/10.4155/fmc.12.95.

Ge R, Sun X, Gu Q, Watt RM, Tanner JA, Wong BC, et al. A proteomic approach for the identification of bismuth-binding proteins in Helicobacter pylori. J Biol Inorg Chem 2007; 12(6):831-42. http://dx.doi.org/10.1007/s00775-007-0237-7.

Nicas TI, Hancock RE. Outer membrane protein H1 of Pseudomonas aeruginosa: Involvement in adaptive and mutational resistance to ethylenediaminetetraacetate, polymyxin B, and gentamicin. J Bacteriol 1980; 143(2):872-8.

Silver S, Phung LT. Bacterial heavy metal resistance: New surprises. Annu Rev Microbiol 1996; 50(1):753-89. http://dx.doi.org/10.1146/annurev.micro.50.1.753.

Luther J, Higgins PD, Schoenfeld PS, Moayyedi P, Vakil N, Chey WD. Empiric quadruple vs. triple therapy for primary treatment of Helicobacter pylori infection: Systematic review and meta-analysis of efficacy and tolerability. Am J Gastroenterol 2010; 105(1):65-73. http://dx.doi.org/10.1038/ajg.2009.508.

The impact of bismuth addition to sequential treatment on Helicobacter pylori eradication: A pilot study

Downloads

Additional Files

Published

25-10-2015

How to Cite

1.
The impact of bismuth addition to sequential treatment on Helicobacter pylori eradication: A pilot study. Biomol Biomed [Internet]. 2015 Oct. 25 [cited 2024 Mar. 28];15(4):50-4. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/573