- Optimizing of Sequential H. pylori Eradication Bismuth-Based Combined with an Adjuvant Therapy in Children with Chronic Gastritis
Optimizing of Sequential H. pylori Eradication Bismuth-Based Combined with an Adjuvant Therapy in Children with Chronic Gastritis
SOVREMENNAYA PEDIATRIYA.2017.4(84):101-106; doi 10.15574/SP.2017.84.101
Shevtsova O. M., Lukashuk V. D., Ali Sameh Ali, Palahniuk N. O.
Bogomolets National Medical University, Kyiv, Ukraine
Objective. To evaluate the efficacy of bismuth-based sequential anti-H. pylori therapy in children with H. pylori CagA-associated chronic gastritis.
Materials and methods. We examined eighty-three patients with chronic gastritis (the main group) aged from six to 17 years who received modified bismuth-based sequential anti-H. pylori therapy. The comparison group (n=64) was administered the 7-day bismuth-based triple therapy (n=31) and standard 7-day lansoprazole-based triple therapy (n=33). For the diagnosis of chronic gastritis, routine diagnostic procedures were performed, including tests for the detection of IgG anti-CagA antibodies in serum to define H. pylori CagA status. The serum 25-hydroxycholecalciferol (vitamin D) value was measured in all patients of the main group before the treatment: 25 children had normal vitamin D levels, and 58 ones had low vitamin D levels or its deficiency. The efficacy of the bismuth-based anti-H. pylori regimens, namely the 10-day sequential (n=83) and 7-day triple (n=31), was compared with the standard 7-day triple therapy in children with chronic gastritis. The 10-day eradication regimen comprised bismuth subcitrate + amoxicillin for the first 5 days, and bismuth subcitrate + amoxicillin + clarithromycin for the next 5 days. The 7-day triple eradication regimen included bismuth subcitrate + amoxicillin + clarithromycin. In six to eight weeks after the completion of therapy, the efficacy of H. pylori eradication was assessed using the stool antigen test.
Results. The eradication rates using the bismuth-based 10-day sequential and 7-day triple therapies were 68.7% and 83.9% respectively, and the rate of standard 7-day triple therapy made up 75.8%. Most of the patients who did not respond to the treatment were children with the vitamin D deficiency, the initially high degree of gastric mucosa colonization, and the 3-5 year duration of H. pylori infection contamination. In the main group, the rate of successful eradication in children with normal vitamin D levels was 84%, and 62.1% in children with low vitamin D levels or vitamin D deficiency. In the group of vitamin D deficiency (n=30) with administered vitamin D as an adjuvant to bismuth-based sequential anti-H. pylori therapy, the eradication rate was 70%, in group without administered an adjuvant (n=28) the eradication rate made up 53.5%.
Conclusions. Both bismuth-based 10-day sequential and 7-day triple anti-H. pylori therapies in children with H. pylori CagA-associated chronic gastritis provided a high rate of H. pylori eradication. Anti-H. pylori therapy should be carried out taking into account the patient's H. pylori CagA status and vitamin D level. In children with vitamin D deficiency, vitamin D as an adjuvant should be used along with the 10-day bismuth-based sequential anti-H. pylori therapy. The above-mentioned combination can increase the rate of successful H. pylori eradication. It is recommended to use the patient's CagA-status and vitamin D level as the additional criteria for the anti-H. pylori therapy selection.
Key words: chronic gastritis, Helicobacter pylori, sequential anti-H. pylori therapy, bismuth subcitrate, vitamin D deficiency, children.
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