The effectiveness of omeprazole, clarithromycin and tinidazole in eradicating Helicobacter pylori in a community screen and treat programme. Leeds Help Study Group.
Aliment Pharmacol Ther
; 14(6): 719-28, 2000 Jun.
Article
em En
| MEDLINE
| ID: mdl-10848655
ABSTRACT
INTRODUCTION:
Helicobacter pylori screening and treatment has been proposed as a cost-effective method of preventing gastric cancer.AIM:
To assess, in a randomized controlled trial, the efficacy of therapy in eradicating H. pylori as part of a screening programme, and to report the adverse events associated with this strategy.METHODS:
Subjects between the ages of 40-49 years were randomly selected from the lists of 36 primary care centres. Participants attended their local practice and H. pylori status was determined by 13C-urea breath test. Infected subjects were randomized to receive omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and tinidazole 500 mg b.d. for 7 days (OCT) or identical placebos. Eradication was determined by a 13C-urea breath test 6 months and 2 years after the first visit. Successful eradication was defined as two negative 13C-urea breath tests or one negative and one missing test. Adverse events and compliance were assessed at the 6-month visit.RESULTS:
A total of 32 929 subjects were invited to attend, 8407 were evaluable, and 2329 (28%) of these were H. pylori-positive. A total of 1161 subjects were randomized to OCT and 1163 to placebo; over 80% returned for a repeat 13C-urea breath test on at least one occasion. The eradication rates in those allocated to OCT were as follows intention-to-treat, 710 out of 1161 (61%; 95% confidence interval 58-64%); evaluable 710 out of 967 (73%; 95% CI 71-76%); took all medication 645 out of 769 (84%; 95% CI 81-87%). Adverse events occurred in 45% of the treatment group and in 18% of the placebo group (relative risk 2.5; 95% CI 2.1-2.9). Compliance, male gender, no antibiotic prescription in the subsequent 2 years and experiencing a bitter taste with the medication were independently associated with treatment success.CONCLUSIONS:
The OCT regimen has an eradication rate of 61% in intention-to-treat analysis and is therefore less successful in treating H. pylori as part of a screening programme compared with hospital studies in dyspeptic patients.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Gástricas
/
Helicobacter pylori
/
Infecções por Helicobacter
/
Antiulcerosos
/
Antibacterianos
/
Antitricômonas
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Screening_studies
Idioma:
En
Revista:
Aliment Pharmacol Ther
Assunto da revista:
FARMACOLOGIA
/
GASTROENTEROLOGIA
/
TERAPIA POR MEDICAMENTOS
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Reino Unido