EVALUATION OF TRIPLE THERAPY VERSUS PROBIOTIC (LACTOBACILLUS REUTERI) - PROTON PUMP INHIBITOR COMBINATION IN ERADICATION OF HELICOBACTER PYLORI

Abstract

The efficacy of commonly prescribed conventional triple therapy drugs such as amoxicillin, clarithromycin and proton pump inhibitor for the treatment of peptic ulcer is decreasing gradually due to the development of antibiotic resistance in the body and also due to the adverse effects caused by frequent use of antibiotics. Probiotics have displayed to have positive effects on the eradication rate of Helicobacter pylori and prevention of side effects associated with antibiotics. The aim of the study was to evaluate and compare the efficacy and safety of conventional triple therapy versus Lactobacillus reuteri + proton pump inhinbitor. The study was conducted in National Medical Center, Karachi on 100 diagnosed patients of peptic ulcer. Male and female patient’s ≥ 18 years of age, fulfilling the inclusion criteria were inducted in the study after informed consent. These patients were systematically randomized into 2 groups each having 50 members. Group A received tablet proton pump inhibitor 20 mg twice daily + Clarithromycin 500 mg BD + Amoxicillin 1 gm BD for 14 days and group B received capsule Lactobacillus reuteri 100 mg twice daily + proton pump inhibitor 20 mg BD for 14 days. The parameters that were investigated include: Hemoglobin (Hb), Liver function test (LFTs), Renal function test (RFTs) and stool antigen test. For the analysis, descriptive statistics were calculated using SPSS version 23. For comparison of two groups A and B, independent T test was used and for comparison of qualitative variables chi-square test was used. The mean Hb in group A at baseline and after 14 days was same 15.00±1.321 % and mean Hb in group B at baseline and after 14 days was also same 14.94±1.399 %. Further, we have found insignificant mean difference for Hb at baseline and after 14 days between the study groups (p=0.999). The mean ALT in group A at baseline and after 14 days was same 25.67±4.033 IU/L while in group B was also same 25.46±4.037 IU/L and the mean AST in group A at baseline and after 14 days was same 28.83±5.335 units/L while in group B was also same 29.59±4.440 units/L along with insignificant mean difference for ALT and AST at baseline and after 14 days between the study groups (p=0.999). The mean serum urea in group A at baseline and after 14 days was same 15.43±2.208 mg/dL while in group B was also same 15.24±1.923 mg/dL and the mean serum creatinine in group A at baseline and xi after 14 days was same 0.83±0.167 while in group B was also same 0.83±0.163 mg/dL along with insignificant mean difference for serum urea and serum creatinine between the study groups (p=0.999). The stool antigen test showed 56.5% positive and 43.5% negative patients in group A while in group B this test showed 34.8% positive and 65.2% negative patients after treatment. When we compared both the groups, we found statistically significant difference between the two groups (p=0.036). Probiotic (Lactobacillus reuteri) along with proton pump inhibitor have shown better efficacy and also helped in minimizing the side effects associated with conventional triple therapy