Intest Res.  2018 Oct;16(4):609-618. 10.5217/ir.2018.00044.

Seven days triple therapy for eradication of Helicobacter pylori does not alter the disease activity of patients with inflammatory bowel disease

• Shinzaki S
• Fujii T
• Bamba S
• Ogawa M
• Kobayashi
• Oshita M
• Tanaka H
• Ozeki K
• Takahashi
• Kitamoto H
• Kani K
• Nanjo S
• Sugaya T
• Sakakibara Y
• Inokuchi T
• Kakimoto K
• Yamada A
• Yasuhara H
• Yokoyama Y
• Yoshino T
• Matsui A
• Nakamura M
• Tomizawa T
• Sakemi R
• Kamata N
• Hibi T

• KMID: 2434163
• DOI: http://doi.org/10.5217/ir.2018.00044

Abstract

BACKGROUND/AIMS
The influences of Helicobacter pylori eradication therapy on the disease course of inflammatory bowel disease (IBD) are still unclear. We therefore conducted a multicenter, retrospective cohort study to evaluate the safety of H. pylori eradication therapy for IBD patients.
METHODS
IBD patients with H. pylori eradication from 2005 to 2015 (eradication group) and control patients (non-eradication group; 2 paired IBD patients without H. pylori eradication matched with each eradicated patient) were included. IBD exacerbation (increased/additional IBD drug or IBD-associated hospitalization/surgery) and disease improvement based on the physicians' global assessment were investigated at baseline, and at 2 and 6 months after eradication or observation.
RESULTS
A total of 429 IBD (378 ulcerative colitis, 51 Crohn's disease) patients, comprising 144 patients in the eradication group and 285 patients in the non-eradication group, were enrolled at 25 institutions. IBD exacerbation was comparable between groups (eradication group: 8.3% at 2 months [odds ratio, 1.76; 95% confidence interval, 0.78-3.92; P=0.170], 11.8% at 6 months [odds ratio, 1.60; 95% confidence interval, 0.81-3.11; P=0.172]). Based on the physicians' global assessment at 2 months, none of the patients in the eradication group improved, whereas 3.2% of the patients in the non-eradication group improved (P=0.019). Multivariate analysis revealed that active disease at baseline, but not H. pylori eradication, was an independent factor for IBD exacerbation during 2 months' observation period. The overall eradication rate was 84.0%-comparable to previous reports in non-IBD patients.
CONCLUSIONS
H. pylori eradication therapy does not alter the short-term disease activity of IBD.

Keyword

Helicobacter pylori eradication; Proton pump inhibitor; Clarithromycin; Metronidazole

MeSH Terms

Clarithromycin
Cohort Studies
Colitis, Ulcerative
Helicobacter pylori*
Helicobacter*
Humans
Inflammatory Bowel Diseases*
Metronidazole
Multivariate Analysis
Retrospective Studies
Clarithromycin
Metronidazole

Figure

• 

  Fig. 1. Definition-based disease exacerbation 2 and 6 months after Helicobacter pylori eradication or observation in IBD patients. Disease exacerbation rates in the eradication group and the non-eradication group were shown. ORs of disease exacerbation were 1.76 (95% CI, 0.78–3.92; P=0.170) at 2 months (A) and 1.60 (95% CI, 0.81–3.11; P=0.172) at 6 months (B), respectively. In 39 patients exacerbated in 6 months after eradication or observation, there were 37 patients with increased/additional IBD drugs, 6 patients with IBD-associated hospitalization, and 2 patients with IBD-associated surgery.

• 

  Fig. 2. Helicobacter pylori eradication success rate in IBD patients. A total of 144 patients in the eradication group was analyzed. Among 123 patients who received primary therapy, clarithromycin was used in 121 patients (98.4%) and unknown in 2 patients. All patients who received secondary therapy were treated with metronidazole.

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