Which therapy is more effective in inactivation of gastric inflammatory? 7 day or 10 day- triple?

H pylori infection has been proved by many studies to induce a chronic inflammatory activity that leads to gastric diseases, especially gastric cancer. The aim of H pylori eradication is to stop this chronic inflammatory activity, being the triple therapy with proton pump inhibitors (PPI) and two antibiotics (amoxicillin associated with clarithromycin or metronidazole) the most preferred first-line therapy regimens in clinical practice. However, the duration of this treatment remains controversial due to the different results worldwide. Although many clinical researches have well demonstrated the histological resolution of the gastric inflammation after H pylori eradication using the first-line therapy for 7 d, 10 d or 14 d, there is not data available comparing 7 d vs 10 d, correlating the histological resolution of gastric inflammation with the bacterial eradication.

A research article to be published on May 14, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Robles-Jara from the Ecuadorian Institute of Digestive Diseases compared a 7-day vs a 10-day triple therapy using a PPI (omeprazole) associated with two antibiotics (amoxicillin and clarithromycin) in a group of 136 patients.

The authors found in this Ecuadorian population that using a 10-day triple therapy is more effective regarding H pylori eradication rates and inflammatory gastric inactivation 8 weeks after treatment. However non-compliance was higher in the 10-day therapy group, as has been previously reported in other clinical trials.

Although their data points to the superior benefits of the 10-day triple therapy, finally the authors are careful before establishing definitive recommendations for the Ecuadorian population. They adduce that every medical treatment must consider the cost-benefit analysis, mainly in developing countries where it is difficult for patients to afford their medicaments in function of its price. This analysis was not assessed in their research and should be performed in future studies.