The appropriate cutoff gastric pH value forHelicobacter pylorieradication with bismuth-based quadruple therapy

作者：Ke, Haoran; Li, Jing; Lu, Bingyun; Yang, Chenghai; Wang, Jiamin; Wang, Zhiqing; Liu, Le; Chen, Ye^*

来源：Helicobacter, 2021, 26(1): e12768.

DOI：10.1111/hel.12768

• 24-h intragastric pH
• Helicobacter pylori
• quadruple therapy

Background This study aimed to investigate whether an increased proton pump inhibitor (PPI) dose enhanced the efficacy ofHelicobacter pylori (H. pylori)eradication and determine the appropriate cutoff intragastric pH value that could predictH. pylorieradication with bismuth-based quadruple therapy. Materials and Methods A total of 207H. pyloriinfected, treatment naive patients were enrolled in this prospective, open-label, randomized controlled trial. Patients were randomly allocated into Eso40-group (esomeprazole 40 mg bid) and Eso20-group (esomeprazole 20 mg bid), and their CYP2C19 genotyping status was assessed. The 24-h intragastric pH monitoring on day 7 was performed, and percentage of time gastric pH >= 3, >= 4, >= 5, and >= 6 (pH holding time ratios; HTRs) were measured.H. pylorieradication was evaluated using(13)C-urea breath test. Results No significant difference in the eradication rates was observed between two groups. The median 24-h intragastric pH value was not significant different between two groups but the Eso40 Group had a significant higher pH4 HTRs (91.11% [95%CI: 87.50%-95.83%] vs. 95.83% [95.83%-100%];p = .002). Additionally, the median 24-h intragastric pH value showed significantly difference between two groups in EM genotype (Eso20 Group 6.00 [95%CI; 5.75-6.15] vs. Eso40 Group 6.30 [6.05-6.30];p = .019). Similar results were observed in pH4 HTRs. There were significant differences in intragastric pH value (6.10 [95%CI: 4.40-7.00] vs. 5.65 [4.85-5.95],p = .038) and in pH4 HTRs (96% [95%CI: 92.00%-96.00%] vs. 87.5% [67.00%-100.0%],p = .019) between eradication-successful and eradication-failed patients. Statistical analysis suggested that the median intragastric pH = 5.7 could identify the success ofH. pylorieradication. Conclusions Bismuth-based quadruple therapy resulted in highH. pylorieradication rates either in PPI standard or double doses. Double dose of esomeprazole is associated with better intragastric acid suppression. A median 24-h intragastric pH of 5.7 could be appropriate cutoff value for predicting the successfulH. pylorieradication.

• 单位
  1; 南方医科大学; 郑州大学; 中国科学院研究生院; y; 同济大学