Elevated serum anti-Helicobacter pylori IgG levels is a predictor of successful eradication therapy
Abstract
AIM: To identify a predictor of successful primary Helicobacter pylori (H. pylori) eradication assessed in routine clinical practice.
METHODS: From February 2013 to January 2015, 186 patients underwent primary eradication therapy. We retrospectively reviewed the medical records. All patients underwent EGD before eradication therapy and H. pylori infection was diagnosed by ≥10 U/ml serum anti-H. pylori IgG. We used standard triple therapy including a proton pump inhibitor (PPI) (rabeprazole 10 mg or lansoprazole 30 mg), clarithromycin 200 mg and amoxicillin 750 mg twice daily for seven days. To determine if eradication succeeded, a 13C-urea breath test was performed on all patients more than eight weeks after primary eradication.
RESULTS: The overall success rate of H. pylori eradication therapy was 62% (116/186). We assessed potential predictors of successful primary H. pylori eradication therapy including gender, age, smoking habits, prior PPI intake, kind of PPI, serum IgG value and degree of atrophy. Univariate analysis showed that high serum IgG significantly predicts successful eradication (odds ratio (OR) 2.583, 95% confidence interval (CI) 1.285-5.191, p = 0.008). The eradication rate was 77% (43/56) in the ≥45 U/ml group and 56% (73/130) in the <45 U/ml group, and significance was confirmed by multivariate analysis (OR 2.626, 95% CI 1.269-5.436, p = 0.009). Multivariate analysis showed a trend that advanced age (≥70 year-old) increased the rate of successful eradication (OR 1.669, 95% CI 0.857-3.252, p = 0.132).
CONCLUSION: Elevated serum IgG significantly predicts successful primary H. pylori eradication.
Keywords
References
Sasaki M, Ogasawara N, Utsumi K, Kawamura N, Kamiya T, Kataoka H, Tanida S, Mizoshita T, Kasugai K, Joh T. Changes in 12-Year First-Line Eradication Rate of Helicobacter pylori Based on Triple Therapy with Proton Pump Inhibitor, Amoxicillin and Clarithromycin. J Clin Biochem Nutr 2010; 47(1): 53-58 [PMID: 20664731 PMCID: PMC2901764 DOI: 10.3164/jcbn.10-10]
Houben MH, van de Beek D, Hensen EF, de Craen AJ, Rauws EA, Tytgat GN. A systematic review of Helicobacter pylori eradication therapy--the impact of antimicrobial resistance on eradication rates. Aliment Pharmacol Ther 1999; 13(8): 1047-1055 [PMID: 10468680]
Furuta T, Ohashi K, Kamata T, Takashima M, Kosuge K, Kawasaki T, Hanai H, Kubota T, Ishizaki T, Kaneko E. Effect of genetic differences in omeprazole metabolism on cure rates for Helicobacter pylori infection and peptic ulcer. Ann Intern Med 1998; 129(12): 1027-1030 [PMID: 9867757]
Tang HL, Li Y, Hu YF, Xie HG, Zhai SD. Effects of CYP2C19 loss-of-function variants on the eradication of H. pylori infection in patients treated with proton pump inhibitor-based triple therapy regimens: a meta-analysis of randomized clinical trials. PLoS One 2013; 8(4): e62162 [PMID: 23646118 PMCID: PMC3639978 DOI: 10.1371/journal.pone.0062162]
Suzuki T, Matsuo K, Sawaki A, Ito H, Hirose K, Wakai K, Sato S, Nakamura T, Yamao K, Ueda R, Tajima K. Systematic review and meta-analysis: importance of CagA status for successful eradication of Helicobacter pylori infection. Aliment Pharmacol Ther 2006; 24(2): 273-280 [PMID: 16842453 DOI: 10.1111/j.1365-2036.2006.02994.x]
Kimura K, Takemoto T. An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis. Endoscopy 1969; 1(3): 87-97 [DOI: 10.1055/s-0028-1098086]
Suzuki T, Matsuo K, Ito H, Sawaki A, Hirose K, Wakai K, Sato S, Nakamura T, Yamao K, Ueda R, Tajima K. Smoking increases the treatment failure for Helicobacter pylori eradication. Am J Med 2006; 119(3): 217-224 [PMID: 16490464 DOI: 10.1016/j.amjmed.2005.10.003]
van Doorn LJ, Schneeberger PM, Nouhan N, Plaisier AP, Quint WG, de Boer WA. Importance of Helicobacter pylori cagA and vacA status for the efficacy of antibiotic treatment. Gut 2000; 46(3): 321-326 [PMID: 10673291 PMCID: PMC1727836]
Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH. Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard. Am J Gastroenterol 1996; 91(10): 2125-2129 [PMID: 8855734]
Morris AJ, Ali MR, Nicholson GI, Perez-Perez GI, Blaser MJ. Long-Term Follow-up of Voluntary Ingestion of Helicobacter pylori. Ann Intern Med 1991; 114(8): 662-663 [DOI: 10.7326/0003-4819-114-8-662]
Wang D, Chiu T, Chiu KW. Clinical implication of immunoglobulin G levels in the management of patients with Helicobacter pylori infection. J Am Board Fam Med 2014; 27(5): 682-689 [PMID: 25201937 DOI: 10.3122/jabfm.2014.05.130181]
Marchildon P, Balaban DH, Sue M, Charles C, Doobay R, Passaretti N, Peacock J, Marshall BJ, Peura DA. Usefulness of serological IgG antibody determinations for confirming eradication of Helicobacter pylori infection. Am J Gastroenterol 1999; 94(8): 2105-2108 [PMID: 10445535 DOI: 10.1111/j.1572-0241.1999.01285.x]
Malm M, Uusi-Kerttula H, Vesikari T, Blazevic V. High serum levels of norovirus genotype-specific blocking antibodies correlate with protection from infection in children. J Infect Dis 2014; 210(11): 1755-1762 [PMID: 24970849 DOI: 10.1093/infdis/jiu361]
Broutet N, Tchamgoue S, Pereira E, Lamouliatte H, Salamon R, Megraud F. Risk factors for failure of Helicobacter pylori therapy--results of an individual data analysis of 2751 patients. Aliment Pharmacol Ther 2003; 17(1): 99-109 [PMID: 12492738]
Sugimoto M, Furuta T, Shirai N, Kodaira C, Nishino M, Ikuma M, Ishizaki T, Hishida A. Evidence that the degree and duration of acid suppression are related to Helicobacter pylori eradication by triple therapy. Helicobacter 2007; 12(4): 317-323 [PMID: 17669104 DOI: 10.1111/j.1523-5378.2007.00508.x]
Shih GL, Brensinger C, Katzka DA, Metz DC. Influence of age and gender on gastric acid secretion as estimated by integrated acidity in patients referred for 24-hour ambulatory pH monitoring. Am J Gastroenterol 2003; 98(8): 1713-1718 [PMID: 12907323 DOI: 10.1111/j.1572-0241.2003.07586.x]
Papastergiou V, Georgopoulos SD, Karatapanis S. Treatment of Helicobacter pylori infection: Past, present and future. World J Gastrointest Pathophysiol 2014; 5(4): 392-399 [PMID: 25400982 PMCID: PMC4231503 DOI: 10.4291/wjgp.v5.i4.392]
Kwon YH, Kim N, Lee JY, Choi YJ, Yoon K, Hwang JJ, Lee HJ, Lee A, Jeong YS, Oh S, Yoon H, Shin CM, Park YS, Lee DH. The Diagnostic Validity of Citric Acid-Free, High Dose (13) C-Urea Breath Test After Helicobacter pylori Eradication in Korea. Helicobacter 2015; 20(3): 159-168 [PMID: 25640474 DOI: 10.1111/hel.12189]
Nishizawa T, Suzuki H, Takahashi M, Suzuki M, Hibi T. Delay of second-line eradication therapy for Helicobacter pylori can increase eradication failure. J Gastroenterol Hepatol 2013; 28(10): 1608-1610 [PMID: 23701705 DOI: 10.1111/jgh.12281]
McNicholl AG, Linares PM, Nyssen OP, Calvet X, Gisbert JP. Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther 2012; 36(5): 414-425 [PMID: 22803691 DOI: 10.1111/j.1365-2036.2012.05211.x]
Kawai T, Takahashi S, Suzuki H, Sasaki H, Nagahara A, Asaoka D, Matsuhisa T, Masaoaka T, Nishizawa T, Suzuki M, Ito M, Kurihara N, Omata F, Mizuno S, Torii A, Kawakami K, Ohkusa T, Tokunaga K, Mine T, Sakaki N. Changes in the first line Helicobacter pylori eradication rates using the triple therapy-a multicenter study in the Tokyo metropolitan area (Tokyo Helicobacter pylori study group). J Gastroenterol Hepatol 2014; 29 Suppl 4: 29-32 [PMID: 25521730 DOI: 10.1111/jgh.12796]
Nishizawa T, Maekawa T, Watanabe N, Harada N, Hosoda Y, Yoshinaga M, Yoshio T, Ohta H, Inoue S, Toyokawa T, Yamashita H, Saito H, Kuwai T, Katayama S, Masuda E, Miyabayashi H, Kimura T, Nishizawa Y, Takahashi M, Suzuki H. Clarithromycin Versus Metronidazole as First-line Helicobacter pylori Eradication: A Multicenter, Prospective, Randomized Controlled Study in Japan. J Clin Gastroenterol 2014 [PMID: 24921211 DOI: 10.1097/mcg.0000000000000165]
Fujiya K, Nagata N, Uchida T, Kobayakawa M, Asayama N, Akiyama J, Shimbo T, Igari T, Banerjee R, Nageshwar Reddy D, Mizokami M, Uemura N. Different gastric mucosa and CagA status of patients in India and Japan infected with Helicobacter pylori. Dig Dis Sci 2014; 59(3): 631-637 [PMID: 24282059 DOI: 10.1007/s10620-013-2961-x]
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