• Meng-Shu Hsieh, Fu-Chen Kuo, Meng-Chieh Wu, Jiunn-Wei Wang, Chung-Jung Liu, Neng-Sheng Chu, Pei-Yun Tsai, Ping-I Hsu, I-Chen Wu, Jeng-Yih Wu, Deng-Chyang Wu, Fang-Jung Yu, and Chao-Hung Kuo.
• Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
• J Formos Med Assoc. 2022 Aug 1; 121 (8): 1450-1457.

Background/PurposeClarithromycin-based standard triple therapy is still commonly adopted by 81.4% of physicians in real-world practice but yields low eradication rates. Therefore, we conducted this study to compare the efficacy of gastric juice-guided therapy for first-line eradication with the standard triple therapy, in order to provide an alternative to real-world practice.MethodsA total of 182 treatment-naïve Hp-infected patients were included and randomly allocated to either susceptibility-guided therapy (SGT) with gastric juice PCR or Clarithromycin-based standard triple therapy (STT) for 7 days.ResultsThe intention-to-treat eradication rates were 89% (81/91) in SGT and 75.8% in STT (p < 0.031). The per-protocol eradication rates were 91.0% (81/89) in SGT and 79.3% (69/87) in STT (p < 0.034). Among the subgroups of different antibiotic resistance, patients with SGT demonstrated superior eradication rates (91.7% vs 45.5%, p < 0.027) in the subgroup of both clarithromycin resistance and levofloxacin resistance.ConclusionThis prospective randomized controlled trial demonstrated the reliable efficacy of susceptibility-guided therapy via gastric juice PCR for the first-line Hp eradication. In Asia-Pacific area, where standard triple therapy is still adopted by the majority of the physicians, it is a recommended alternative to overcome the increasing antibiotic resistance.Copyright © 2021. Published by Elsevier B.V.

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