Rabeprazole‐based eradication therapy for Helicobacter pylori: a large‐scale study in Japan

Abstract

Background Large‐scale studies of rabeprazole‐based Helicobacter pylori eradication therapy have not been reported in Japan. Aims To evaluate H. pylori eradication by rabeprazole‐based therapy with reference to antibiotic susceptibility, CYP2C19 genotype, and rabeprazole and clarithromycin dosages. Methods From 35 centres 479 H. pylori‐positive patients with gastric or duodenal ulcer were randomized to four treatment groups: Group 1 (10 mg rabeprazole + 750 mg amoxicillin + 200 mg clarithromycin twice daily for 7 days); Group 2 (10 mg, 750 mg, 400 mg); Group 3 (20 mg, 750 mg, 200 mg) and Group 4 (20 mg, 750 mg, 400 mg). Results Eradication rates were 86% (102 of 119), 89% (97 of 109), 91% (106 of 116) and 90% (104 of 115) for Groups 1–4, respectively. The eradication rate was 95% (360 of 379) for clarithromycin‐susceptible strains, and 50% (30 of 60) for clarithromycin‐resistant strains. The eradication rates were 88% (332 of 379) and 96% (77 of 80) in extensive metabolizers and poor metabolizers, respectively. Conclusions Rabeprazole‐based therapies achieved 50% eradication of clarithromycin‐resistant H. pylori, and even achieved good rates in extensive metabolizers. Accordingly, rabeprazole can be recommended as part of a first‐line proton pump inhibitor‐based triple therapy for H. pylori.