Adding diclofenac to Helicobacter pylori eradication regimen

Authors
Mohammad Hasan Emami 1
Akbar Arjmandpour 1
Hamed Daghaghzadeh 1
Hojatollah Rahimi 1
Ali Toghiani 2
Peyman Adibi 3
1 Department of Internal Medicine, School of Medicine, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Young Researchers and Elite Club, Najafabad Branch, Islamic Azad University, Najafabad, Iran
3 Department of Medicine, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Helicobacter pylori colonizes not only on the surface of mucous membrane, but also beneath the surface mucous gel layer (SMGL). As diclofenac Na decreases the secretion of SMGL, in this study we examined this drug as an adjuvant therapy to a quadruple therapy for H. Pylori eradication.
Materials and Methods: One hundred and seventy-two patients were randomly assigned to three groups. Fifty four patients received quadruple therapy, that is, azithromycine 250 mg, amoxicillin 500 mg, bismuth subcitrate 240 mg, and omeprazole 20 mg bid for 1 week (group A) and 65 patients received the same dosage of those agents plus diclofenac Na tab, 100 mg daily for 1 week (group B). Sixty two patients received the quadruple therapy for 2 weeks (group C). Eradication of the infection was assessed 4-6 weeks after completion of treatment by stool antigen assay for H. pylori.
Results: While the rate of H. pylori eradication in the groups A and B was 66.7% and 82.1%, respectively (P = 0.062), the rate of H. pylori eradication in groups B and C were 82.1% and 82.3% respectively (P = 0.987).
Conclusions: It seems that diclofenac Na can shorten anti-H. pylori regimens for 1 week. More investigations are needed for more clarification of the efficacy of NSAIDs for successful eradication of H. pylori. (IRCT code: IRCT201204059256N2)

Keywords

1.
Steininger S, Pelz C, Vogelmann R. Purpose of recently detected inhibitory domain of the Helicobacter pylori protein CagA. Gut Microbes 2011;2:167-72.  Back to cited text no. 1
    
2.
Taghvaei T, Talebi Bezmin Abadi A, Ghasemzadeh A, Naderi BK, Mohabbati Mobarez A. Prevalence of horB gene among the Helicobacter pylori strains isolated from dyspeptic patients: First report from Iran. Intern Emerg Med 2012;7:505-8.  Back to cited text no. 2
    
3.
Shimizu T, Akamatsu T, Sugiyama A, Ota H, Katsuyama T. Helicobacter pylori and the surface mucous gel layer of the human stomach. Helicobacter 1996;1:207-18.  Back to cited text no. 3
    
4.
Chuah SK, Tsay FW, Hsu PI, Wu DC. A new look at anti-Helicobacter pylori therapy. World J Gastroenterol 2011;17:3971-5.  Back to cited text no. 4
    
5.
Ruggiero P. Helicobacter pylori infection: What's new. Curr Opin Infect Dis 2012;25:337-44.  Back to cited text no. 5
    
6.
Selgrad M, Malfertheiner P. Treatment of Helicobacter pylori. Curr Opin Gastroenterol 2011;27:565-70.  Back to cited text no. 6
    
7.
Hu CT, Wu CC, Lin CY, Cheng CC, Su SC, Tseng YH, et al. Resistance rate to antibiotics of Helicobacter pylori isolates in eastern Taiwan. J Gastroenterol Hepatol 2007;22:720-3.  Back to cited text no. 7
    
8.
Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: Duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007;147:553-62.  Back to cited text no. 8
    
9.
Fischbach L, Evans EL. Meta-analysis: The effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther 2007;26:343-57.  Back to cited text no. 9
    
10.
Sun Q, Liang X, Zheng Q, Liu W, Xiao S, Gu W, et al. High efficacy of 14-day triple therapy-based, bismuth-containing quadruple therapy for initial Helicobacter pylori eradication. Helicobacter 2010;15:233-8.  Back to cited text no. 10
    
11.
Malfertheiner P, Bazzoli F, Delchier JC, Celiñski K, Giguère M, Rivière M, et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: A randomised, open-label, non-inferiority, phase 3 trial. Lancet 2011;377:905-13.  Back to cited text no. 11
    
12.
Albrecht P, Kotowska M, Szajewska H. Sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children: A double-blind, randomized, controlled trial. J Pediatr 2011;159:45-9.  Back to cited text no. 12
    
13.
Garner A, Allen A, Rowe PH. Gastroduodenal mucosal defence mechanisms and the action of non-steroidal anti-inflammatory agents. Scand J Gastroenterol Suppl 1987;127:29-34.  Back to cited text no. 13
    
14.
Gokturk HS, Demir M, Unler GK, Erbayrak M, Sakalli M, Yilmaz U. Does long-term aspirin use have any effect on Helicobacter pylori eradication? Am J Med Sci 2011;342:15-9.  Back to cited text no. 14
    
15.
Park SH, Park DI, Kim SH, Kim HJ, Cho YK, Sung IK, et al. Effect of high-dose aspirin on Helicobacter pylori eradication. Dig Dis Sci 2005;50:626-9.  Back to cited text no. 15
    
16.
Zhang LJ, Wang SY, Huo XH, Zhu ZL, Chu JK, Ma JC, et al. Anti-Helicobacter pylori therapy followed by celecoxib on progression of gastric precancerous lesions. World J Gastroenterol 2009;15:2731-8.  Back to cited text no. 16
    
17.
Moshkowitz M, Konikoff FM, Peled Y, Santo M, Hallak A, Bujanover Y, et al. High Helicobacter pylori numbers are associated with low eradication rate after triple therapy. Gut 1995;36:845-7.  Back to cited text no. 17
    
18.
Caselli M, Pazzi P, LaCorte R, Aleotti A, Trevisani L, Stabellini G. Campylobacter-like organisms, nonsteroidal anti-inflammatory drugs and gastric lesions in patients with rheumatoid arthritis. Digestion 1989;44:101-4.  Back to cited text no. 18
    
19.
Zhang XP, Wang WH, Tian Y, Gao W, Li J. Aspirin increases susceptibility of Helicobacter pylori to metronidazole by augmenting endocellular concentrations of antimicrobials. World J Gastroenterol 2009;15:919-26.  Back to cited text no. 19
Advanced Biomedical Research
Volume 2015, july
July 2015
Pages 1-4