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J Clin Biochem Nutr. 2017 May;60(3):208-210. doi: 10.3164/jcbn.16-86. Epub 2017 Feb 16.

Effects of patient age and choice of antisecretory agent on success of eradication therapy for Helicobacter pylori infection.

Author information

1
Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan.
2
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
3
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
4
Medical Education Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
5
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
6
Department of Gastroenterology, Kanto Central Hospital, Tokyo 158-8531, Japan.
7
Department of Surgery, Japanse Red Cross Medical Center, Tokyo 150-8935, Japan.

Abstract

The effects of patient age on the efficacy of eradication treatment for Helicobacter pylori (H. pylori) remain unclear. The present study aimed to determine whether age affects eradication therapy involving vonoprazan, a novel potassium-competitive acid blocker (PCAB). We reviewed the cases of 3,261 patients who were administered first-line and second-line H. pylori eradication therapy at Toyoshima Endoscopy Clinic. The first-line treatment was clarithromycin and amoxicillin combined with a proton pump inhibitor (PPI) or a PCAB. The second-line treatment was metronidazole and amoxicillin combined with a PPI or PCAB. The patients were divided into a young to middle-aged group (age ≤50 years) and an older group (age >50 years) as well as into PPI and PCAB groups. The PPI-clarithromycin-amoxicillin regimen demonstrated a significantly lower H. pylori eradication rate than the PCAB-clarithromycin-amoxicillin regimen (p<0.001). With the PPI-clarithromycin-amoxicillin regimen, the eradication rate in the young to middle-aged group was significantly lower than that in the older group (p<0.001). Lastly, age had no impact on the eradication rate of PCAB-based therapy or metronidazole-based therapy. In conclusion, with clarithromycin-based triple therapy, PCAB is a better choice of antisecretory agent compared to PPIs, especially in young to middle-aged patients.

KEYWORDS:

H. pylori; age; eradication; proton pump inhibitor; vonoprazan

Conflict of interest statement

During the last two years, HS received scholarship funds for the research from Daiichi-Sankyo Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Shionogi Pharm. Co., Ltd., Takeda Pharmaceutical Co., Ltd., Toshiba Co., Ltd. and Tsumura Co., Ltd., and received service honoraria from Astellas Pharm Inc., Astra-Zeneca K.K., EA Pharma. Co., Ltd., Mylan EPD Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Tsumura Co., Ltd., and Zeria Pharmaceutical Co., Ltd. TK received scholarship funds for the research from Astellas Pharm Inc., Astra-Zeneca K.K., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Eisai Pharmaceutical Co., Ltd., Zeria Pharmaceutical Co., Ltd., Tanabe Mitsubishi Pharmaceutical Co., Ltd., JIMRO Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and received service honoraria from Astellas Pharm Inc., Eisai Pharmaceutical Co., Ltd., JIMRO Co., Ltd., Tanabe Mitsubishi Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., and Zeria Pharmaceutical Co., Ltd. NY received scholarship funds for the research from Takeda Pharmaceutical Co., Ltd., Eisai Co., Ltd., Kaigen Pharm Co., Ltd., Boston Scientific Japan K.K., Nihon Pharmaceutical Co., Ltd., Hoya corporation and Otsuka Pharmaceutical Co., Ltd. The funding source had no role in the design, practice or analysis of this study. There are no other conflicts of interests for this article.

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