Concomitant therapy versus triple therapy: efficacy in H. Pylori eradication and predictors of treatment failure

Abstract

Objective: To compare concomitant therapy (CT) and triple therapy (TRT) for success in helicobacter (H.) pylori eradication and identify factors associated with treatment failure. Study Design: Quasi-experimental comparative study. Place and Duration of Study: Department of Medicine and Gastroenterology, Services Institute of Medical Sciences from December 2018 till July 2019. Methodology: Patients with H. pylori infection were randomly assigned to receive two weeks of either CT or TRT. H. pylori eradication was confirmed by repeat biopsy four weeks post-treatment. Treatment outcome was compared using Chi-square test, while binary logistic regression identified predictors of treatment failure. Results: Two hundred and eleven patients with H. pylori infection, having mean age 40.15 (±13.04) and male/female ratio 0.9/1 (100/111) after randomisation, were treated with CT in 105 patients (49.8%) and TRT in 106 patients (50.2%). H. pylori was eradicated in 84.3% (150/178) patients with completed follow-up. H. pylori eradication was achieved in 91.9% of CT group as compared to 77.2% in TRT group (p = 0.007, OR 3.38: 95% CI 1.3-8.3). Age ≥40 years (p = 0.02), symptoms duration >6 months (p = 0.001), and prior proton pump inhibitor use for >4 weeks (p = 0.01), were identified as independent predictors of treatment failure. Conclusion: CT achieves better H. pylori eradication than TRT. Older age, longer duration of illness, and previous proton pump inhibitor use were independent predictors of H. pylori treatment failure.