The appropriate cutoff gastric pH value for Helicobacter pylori eradication with bismuth-based quadruple therapy

Haoran Ke; Jing Li; Bingyun Lu; Chenghai Yang; Jiamin Wang; Zhiqing Wang; Le Liu; Ye Chen

doi:10.1111/hel.12768

The appropriate cutoff gastric pH value for Helicobacter pylori eradication with bismuth-based quadruple therapy

Helicobacter. 2021 Feb;26(1):e12768. doi: 10.1111/hel.12768. Epub 2020 Oct 21.

Authors

Haoran Ke¹, Jing Li^{1

2}, Bingyun Lu^{1

3}, Chenghai Yang¹, Jiamin Wang^{1

4}, Zhiqing Wang¹, Le Liu¹, Ye Chen¹

Affiliations

¹ Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
⁴ Department of Gastroenterology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China.

PMID: 33089598
DOI: 10.1111/hel.12768

Abstract

Background: This study aimed to investigate whether an increased proton pump inhibitor (PPI) dose enhanced the efficacy of Helicobacter pylori (H. pylori) eradication and determine the appropriate cutoff intragastric pH value that could predict H. pylori eradication with bismuth-based quadruple therapy.

Materials and methods: A total of 207 H. pylori infected, 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. pylori eradication 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 of H. pylori eradication.

Conclusions: Bismuth-based quadruple therapy resulted in high H. pylori eradication 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 successful H. pylori eradication.

Keywords: Helicobacter pylori; 24-h intragastric pH; CYP2C19; quadruple therapy.

Publication types

Randomized Controlled Trial

MeSH terms

Anti-Bacterial Agents* / therapeutic use
Bismuth* / therapeutic use
Drug Therapy, Combination
Esomeprazole / therapeutic use
Helicobacter Infections* / drug therapy
Helicobacter pylori
Humans
Hydrogen-Ion Concentration*
Prospective Studies
Proton Pump Inhibitors* / therapeutic use
Treatment Outcome

Substances

Anti-Bacterial Agents
Proton Pump Inhibitors
Esomeprazole
Bismuth

Grants and funding

AstraZeneca