Ten days of treatment may be enough to eradicate a bacterium blamed for 90 percent of stomach ulcers. Currently, the most commonly prescribed treatments run 14 to 28 days and involve multiple doses of pills each day.
A research team led by the Division of Gastroenterology at Oregon Health Sciences University has shown that 10 days of treatment involving a combination of three drugs is as effective at getting rid of H. pylori as 14 days of treatment. The research is being published in the August edition of the Archives of Internal Medicine.
"This research should have a major impact," said M. Brian Fennerty, M.D., associate professor of medicine in OHSU's Division of Gastroenterology and lead author of the article. "A shorter drug regimen is less expensive and should ensure that more patients complete their full treatment. With millions of Americans suffering from stomach ulcers, the savings could add up to many millions of dollars." Based in part on the results of this research, the U.S. Food and Drug Administration recently reduced the recommended length of treatment for H. pylori from 14 to 10 days.
The research focused on "triple therapy," which has been shown to have a higher H. pylori cure rate than other methods. The triple therapy is a combination of three drugs: a powerful acid-inhibiting drug called a proton-pump inhibitor (such as lansoprazole) along with amoxicillin and clarithromycin. The study included 236 patients at 46 study sites around the U.S. including OHSU. Patients in the study took the triple therapy drugs twice a day for either 10 or 14 days. Among those patients who followed the full course of treatment, H. pylori was eradicated in 85 percent of patients on the 14-day treatment and in 84 percent of patients on the 10-day regimen, a statistically insignificant difference. "With this knowledge, we're hopeful of achieving a higher cure rate for H. pylori. Ten days is a much more patient-friendly treatment regimen than 14 days. If there are fewer pills to take, you stand a better chance that patients will take all their pills."
Treatment of H. pylori has been one of the big medical success stories of the past two decades. The bacterium is almost always acquired in infancy--from contact with feces or bodily fluids--and exists harmlessly in many adults' digestive systems. Thanks to improved public hygeine, the incidence of H. pylori has been dropping steadily over the past decades. Stomach ulcer patients in whom H. pylori is eradicated have only a 15 to 20 percent chance of suffering from another ulcer. Those who still carry H. pylori have a 75 percent chance of recurrence.
Fennerty said he hopes this research, along with the F.D.A.'s new guideline, will encourage more providers to adopt the 10-day treatment standard. "This provides scientific evidence to back up providers' decisions to choose the 10-day regimen. And we encourage patients to talk with their providers about a shorter treatment period."
Dr. Fennerty is available for interviews. Call Henry Sessions at (503) 494-8231 to arrange a time.
Other contributors to the article include: The Center for Ulcer Research and Education, Los Angeles; Allegheny University of the Health Sciences, Philadelphia; Microbiology Specialists, Houston; and TAP Holdings of Deerfield, Illinois, which also funded the study.
Journal
Archives of Internal Medicine