Standard First-line Triple Therapy forHelicobacter pyloriInfection: A Comparison of Eradication Rates Based on Timing of Administration of Proton Pump Inhibitors

Background/Aims: Recent Korean studies performed over the past few decades have shown diminishing efficacy and unacceptability of clarithromycin-based triple therapy as first-line eradication therapy for Helicobacter pylori infection, based on evidence of a declining eradication rate.Triple therapy continues to be used as first-line eradication therapy despite concerns regarding high clarithromycin resistance among Koreans.Patient compliance and acid suppression are important factors associated with the H. pylori eradication rate.We investigated whether regular administration of a proton pump inhibitor (PPI) 30 minutes before a meal can improve the eradication rate. Materials and Methods:We retrospectively analyzed the data of 316 patients who were treated with first-line triple therapy (PPI, amoxicillin, and clarithromycin) for H. pylori infection between January 2012 and September 2017.Patients were divided into 2 groups based on the time of administration of the PPI (group A: before a meal, group B: after a meal).The urea breath test was performed 4∼6 weeks after eradication of infection.Results: Notably, 249 patients (78.8%, 249/316) showed successful eradication.The eradication rates in groups A and B were 87.5% (49/56 patients) and 76.9% (200/260 patients), respectively.We observed that regular administration of PPI before meals improved the eradication rate (P=0.079). Conclusions:We observed that although clarithromycin-based triple therapy was associated with an overall eradication rate ＜80%, regular PPI administration before meals improved the eradication rate.Regular PPI administration before meals and effective education to improve patient compliance could improve the eradication rate through maximal acid suppression.(Korean