A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North
BACKGROUND: Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.OBJECTIVE: To co...
Published in: | Canadian Journal of Gastroenterology |
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fthindawi:oai:hindawi.com:10.1155/2013/143047 2023-05-15T13:07:59+02:00 A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North Amy L Morse Karen J Goodman Rachel Munday Hsiu-Ju Chang John Morse Monika Keelan Janis Geary Sander Veldhuyzen van Zanten CAN Help Working Group 2013 https://doi.org/10.1155/2013/143047 en eng Canadian Journal of Gastroenterology https://doi.org/10.1155/2013/143047 Copyright © 2013 Hindawi Publishing Corporation. Original Article 2013 fthindawi https://doi.org/10.1155/2013/143047 2019-05-26T05:17:38Z BACKGROUND: Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.OBJECTIVE: To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminating H pylori infection in Aklavik.METHODS: Treatment-naive H pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistant H pylori were randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.RESULTS: Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.CONCLUSIONS: While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standard H pylori treatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik. Article in Journal/Newspaper Aklavik Arctic Hindawi Publishing Corporation Aklavik ENVELOPE(-135.011,-135.011,68.219,68.219) Arctic Canadian Journal of Gastroenterology 27 12 701 706 |
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Open Polar |
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Hindawi Publishing Corporation |
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fthindawi |
language |
English |
description |
BACKGROUND: Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.OBJECTIVE: To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminating H pylori infection in Aklavik.METHODS: Treatment-naive H pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistant H pylori were randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.RESULTS: Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.CONCLUSIONS: While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standard H pylori treatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik. |
format |
Article in Journal/Newspaper |
author |
Amy L Morse Karen J Goodman Rachel Munday Hsiu-Ju Chang John Morse Monika Keelan Janis Geary Sander Veldhuyzen van Zanten CAN Help Working Group |
spellingShingle |
Amy L Morse Karen J Goodman Rachel Munday Hsiu-Ju Chang John Morse Monika Keelan Janis Geary Sander Veldhuyzen van Zanten CAN Help Working Group A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North |
author_facet |
Amy L Morse Karen J Goodman Rachel Munday Hsiu-Ju Chang John Morse Monika Keelan Janis Geary Sander Veldhuyzen van Zanten CAN Help Working Group |
author_sort |
Amy L Morse |
title |
A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North |
title_short |
A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North |
title_full |
A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North |
title_fullStr |
A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North |
title_full_unstemmed |
A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North |
title_sort |
randomized controlled trial comparing sequential with triple therapy for helicobacter pylori in an aboriginal community in the canadian north |
publisher |
Canadian Journal of Gastroenterology |
publishDate |
2013 |
url |
https://doi.org/10.1155/2013/143047 |
long_lat |
ENVELOPE(-135.011,-135.011,68.219,68.219) |
geographic |
Aklavik Arctic |
geographic_facet |
Aklavik Arctic |
genre |
Aklavik Arctic |
genre_facet |
Aklavik Arctic |
op_relation |
https://doi.org/10.1155/2013/143047 |
op_rights |
Copyright © 2013 Hindawi Publishing Corporation. |
op_doi |
https://doi.org/10.1155/2013/143047 |
container_title |
Canadian Journal of Gastroenterology |
container_volume |
27 |
container_issue |
12 |
container_start_page |
701 |
op_container_end_page |
706 |
_version_ |
1766071201171505152 |