A Quasi Experimental Study of Helicobacter Pylori Eradication in Afghanistan: Comparison of Treatment Preferences for Helicobacter Pylori Eradications, Sequential Therapy Versus Hybrid Therapy

Rauf Jan; Sher Alam; Najeebullah; Mohammad Ashraf Zadran

doi:10.55544/jrasb.2.4.15

Authors

Rauf Jan Lecturer, Faculty of Medical, Shiakh Zayed University, AFGHANISTAN.
Sher Alam Lecturer, Faculty of Medical, Shiakh Zayed University, AFGHANISTAN.
Najeebullah Lecturer, Faculty of Medical, Shiakh Zayed University, AFGHANISTAN.
Mohammad Ashraf Zadran Trainer, Assistant Clinical Professor of Internal Medicine, Khost Post Graduated Hospital, AFGHANISTAN.

DOI:

https://doi.org/10.55544/jrasb.2.4.15

Keywords:

H. Pylori, Hybrid treatment, Sequential treatment, Afghanistan

Abstract

Colonization by Helicobacter pylori (H. pylori) of the gastric epithelial lining epitomizes a pervasive and clinically consequential infectious etiology. Therapeutic strategies aimed at bacterial eradication inherently hinge on a confluence of determinants-regional antimicrobial resistance spectra, localized clinical algorithms, and pharmaceutical attainability. Best practices in the medical milieu underscore sagacious antibiotic stewardship, predicated on a patient-centric antibiotic historiography prior to therapeutic commencement.

The overarching objective of this study-executed in a quasi-experimental comparative framework at Sheikh Zayed University Teaching Hospital, Khost, Afghanistan-was to discerningly evaluate and contrast two paradigms of treatment: Sequential Therapy and Hybrid Therapy. The subject pool encapsulated a demographically diverse set of individuals, aged 16 to 80, manifesting symptoms of peptic ulcer diseases or gastritis. Those ineligible for inclusion included follow-up patients, immunocompromised subjects, and individuals undergoing oncological interventions.

Employing the Statistical Package for the Social Sciences (SPSS) Version 25 for data stratification, the Hybrid Therapy arm was subjected to an initial seven-day treatment window with amoxicillin (1g, BID) and omeprazole (20mg, BID), succeeded by a seven-day regimen involving clarithromycin (500mg, BID) and metronidazole (400mg, TID). Conversely, the Sequential Therapy cohort received a bifurcated, five-day course of omeprazole and amoxicillin, followed by an additional five-day regimen of omeprazole, metronidazole, and clarithromycin. Outcome variables, inclusive of treatment efficaciousness, regimen completion, and patient adherence, were rigorously evaluated via Chi-Square statistical testing.

Encompassing 145 patients, the study observed a gender dispersion of 156 males (41.1%) to 224 females (58.9%). Per-protocol analysis unveiled a statistically significant eradication rate-86.8% vs 83.0% (P=0.021)-tilted in favor of Hybrid Therapy. Both Modified Intention-to-Treat and Intention-to-Treat analyses corroborated this proclivity, registering significant eradication rates of 92.1% versus 67% (P=0.031) for Hybrid Therapy.

Conclusively, Hybrid Therapy demonstrated a superior safety and efficacy profile vis-à-vis Sequential Therapy in extirpating H. pylori, intimating its plausible preferability for the clinical management of associated peptic ulcer diseases and gastritis.

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References

Chang SN, Shih YH, Lee WC, Kuo MT, Tsay FW, Kuo LF, Huang WW, Shie CB (2020). 14‐day reverse hybrid therapy vs 7‐day concomitant therapy in the first‐line treatment of Helicobacter pylori infection. Advances in Digestive Medicine.

Chey WD, Leontiadis GI, Howden CW, Moss SF (2017). ACG clinical guideline: treatment of Helicobacter pylori infection. Official journal of the American College of Gastroenterology| ACG. Feb 1;112(2):212-39.

Di Ciaula A, Scaccianoce G, Venerito M, Zullo A, Bonfrate L, Rokkas T, Portincasa P (2017). Eradication rates in Italian subjects heterogeneously managed for Helicobacter pylori infection. Time to abandon empiric treatments in Southern Europe. Journal of Gastrointestinal and Liver Diseases. Jun 1;26(2).

Graham DY, Shiotani A (2012). Which therapy for Helicobacter pylori infection?. Gastroenterology. Jul 1;143(1):10-2.

Howden CW, Chey WD, Vakil NB (2014). Clinical rationale for confirmation testing after treatment of Helicobacter pylori infection: Implications of rising antibiotic resistance. Gastroenterology and hepatology. Jul;10(7 Suppl 3):1.

Huang CC, Tsai KW, Tsai TJ, Hsu PI (2017). Update on the first-line treatment for Helicobacter pylori infection-a continuing challenge from an old enemy. Biomarker research. Dec;5(1):1-6.

Jung HK, Kang SJ, Lee YC, Yang HJ, Park SY, Shin CM, Kim SE, Lim HC, Kim JH, Nam SY, Shin WG (2021). Evidence- Based Guidelines for the Treatment of Helicobacter pylori Infection in Korea 2020. Gut and Liver. Mar 15;15(2):168.

Lin YH, Lin JH, Chou SC, Chang SJ, Chung CC, Chen YS, Chang CH (2015). Berberine-loaded targeted nanoparticles as specific Helicobacter pylori eradication therapy: in vitro and in vivo study. Nanomedicine. Jan;10(1):57-71.

Liou JM, Chen PY, Kuo YT, Wu MS (2018). Toward population specific and personalized treatment of Helicobacter pylori infection. J. Biomed. Sci. Dec;25(1):1-1.

Mahachai V, Vilaichone RK, Pittayanon R, Rojborwonwitaya J, Leelakusolvong S, Maneerattanaporn M, Chotivitayatar- akorn P, Treeprasertsuk S, Kositchaiwat C, Pisespongsa P, Mairiang P (2018). Helicobacter pylori management in ASEAN: The Bangkok consensus report. J. Gastroenterol. Hepatol. Jan;33(1):37-56.

Marcus EA, Sachs G, Scott DR (2016). Eradication of Helicobacter pylori infection. Current gastroenterology reports. Jul 1;18(7):33.

Mohsina S, Muthusami A, Shankar G, Sureshkumar S, Kate V (2016). Helicobacter pylori eradication in complicated peptic ulcer: Beneficial in most?. Int. J. Adv. Med. Health Res. Feb 1;3(2):58.

O'Connor A, Liou JM, Gisbert JP, O'Morain C (2019). treatment of Helicobacter pylori infection 2019. Helicobacter. Sep;24:e12640.

Tai WC, Liang CM, Lee CH, Chiu CH, Hu ML, Lu LS, Kuo YH, Kuo CM, Yen YH, Kuo CH, Chiou SS (2015). Seven-day nonbismuth containing quadruple therapy could achieve a grade “A” success rate for first-line Helicobacter pylori eradication. BioMed research international. May 19;2015.

Talebi Bezmin Abadi A (2014). Therapy of Helicobacter pylori: present medley and future prospective. BioMed Research International. Apr 1;2014.

Vlăduţ C, Ciocîrlan M, Costache RS, Jinga M, Balaban VD, Costache DO, Diculescu M (2020). Is mucosa-associated lymphoid tissue lymphoma an infectious disease? Role of Helicobacter pylori and eradication antibiotic therapy. Experimental and Therapeutic Medicine. Oct 1;20(4): 3546-53.

Yang C, Liu L, Majaw JK, Liang L, Chen Y (2021). Efficacy of Lactobacillus reuteri supplementation therapy for Helicobacter pylori eradication: A meta-analysis of randomised controlled trials. Medicine in Microecology. Jul 16:100036.

Yuan Y, Ford AC, Khan KJ, Gisbert JP, Forman D, Leontiadis GI, Tse F, Calvet X, Fallone C, Fischbach L, Oderda G (2013). Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database of Systematic Reviews. (12).