Cure of Helicobacter pylori infection in the elderly: Effects of eradication on gastritis and serological markers

A. Pilotto, F. Di Mario, M. Franceschi, G. Leandro, G. Soffiati, M. Scagnelli, L. Bozzola, G. Valerio

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Specific data on anti-H. pylori treatments in elderly people are very scarce. The aim of the study was to evaluate in the elderly the efficacy of different anti H. pylori therapies and the behaviour of serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio induced by the anti-H. pylori treatment. Methods: One hundred and twenty-one dyspeptic patients aged >60 years (mean age, 73 years; range, 61-89 years) with H. pylori-positive gastric ulcers (17 patients), duodenal ulcers (33 patients) or chronic gastritis (71 patients) were treated with one of the following anti-H. pylori treatments: (A) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days; (B) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 mg q.d.s. for 7 days; (C) omeprazole 40 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 q.d.s. for 7 days; (D) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days; (L) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days plus metronidazole 250 q.d.s. for 7 days; and (P) omeprazole 40 mg/day plus clarithromycin 250 mg b.d. for 7 days plus metronidazole 250 mg q.d.s. for 7 days. At the baseline and 2 months after therapy, endoscopy and serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio were measured. Results: Ten patients (8.2%) dropped out of the study. Six patients (4.9%) reported side-effects. The eradication rates of the six regimens, expressed using intention-to-treat and per protocol analysis, were, respectively: (A) 39% and 44%; (B) 50% and 56%; (C) 65% and 77%; (D) 47% and 50%; (E) 85% and 90%; and (F) 83% and 87%. The triple therapy for regimens E and F was significantly more effective than dual therapies (regimens A and D; intention-to-treat = P <0.007, per protocol = P <0.001) or the triple therapy for regimens B and C (intention-to-treat = P <0.009, per protocol =P <0.03). Patients cured of H. pylori infection showed a significant decrease in the activity of gastritis (P <0.0001), a significant drop in IgG anti-H. pylori (P = 0.0004) and pepsinogen C (P <0.0001), and an increase in PGA/PGC ratio (P <0.001), while patients remaining H. pylori positive showed no changes in the serum parameters. Conclusions: In the elderly, triple therapy with omeprazole + metronidazole + clarithromycin for 1 week is well tolerated and highly effective; anti-H. pylori antibody and PGC serum levels decrease soon after anti-H. pylori therapy only in patients cured of H. pylori infection.

Original languageEnglish
Pages (from-to)1021-1027
Number of pages7
JournalAlimentary Pharmacology and Therapeutics
Volume10
Issue number6
Publication statusPublished - 1996

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

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