Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection

BACKGROUND: Low-dose rabeprazole-based triple therapy was effective for Helicobacter pylori eradication in a few Japanese studies. AIM: To compare the effectiveness of 1-week low-dose and high-dose rabeprazole-based triple therapy with those of omeprazole. METHODS: One hundred and sixty-two H. pylori-infected dyspeptic patients were randomized to receive twice daily for 1 week either rabeprazole 10 mg (R10), rabeprazole 20 mg (R20) or omeprazole 20 mg (O) in combination with amoxicillin 1,000 mg (A) and clarithromycin 500 mg (C). H. pylori status assessment was by the CLO test and histology at entry and by the 13C-urea breath test at 4-6 weeks after cessation of therapy. RESULTS: H. pylori eradication rates in intention-to-treat groups were 85%, 96% and 83% for R10AC, R20AC and OAC, respectively. Eradication rates in per protocol groups were 86%, 96% and 90% for R10AC, R20AC and OAC, respectively. On an intention-to-treat analysis, the R20AC group had a significantly higher eradication rate than did R10AC or OAC (P < 0.05). However, the higher eradication rate with R20AC did not reach statistical significance in the per protocol analysis. Drug intolerance was found in three OAC patients. CONCLUSION: High-dose rabeprazole-based triple therapy is more effective than its low-dose equivalent or omeprazole in eradicating H. pylori infection.