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Korean J Gastroenterol 2019; 73(2): 99-104  https://doi.org/10.4166/kjg.2019.73.2.99
Eradication Rates of 10-day Sequential Therapy for Helicobacter pylori: Results of an 8-year Prospective Study Conducted at a Tertiary Korean Hospital
Kichul Yoon1,2 and Nayoung Kim1,3
Department of Internal Medicine, Seoul National University Bundang Hospital1, Seongnam; Department of Internal Medicine, Wonkwang University Sanbon Hospital2, Gunpo; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine3, Seoul, Korea
Correspondence to: Nayoung Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel: +82-31-787-7008, Fax: +82-31-787-4051, E-mail: nayoungkim49@empas.com, ORCID: https://orcid.org/0000-0002-9397-0406
Received: February 1, 2019; Revised: February 5, 2019; Accepted: February 7, 2019; Published online: February 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background/Aims: The Helicobacter pylori (H. pylori) eradication rate of standard triple therapy is unsatisfactory in Korea, and sequential therapy (SQT) has been suggested to be a practical first-line alternative regimen. The aim of this prospective study was to document changes in annual eradication rates of SQT.
Methods: A total of 983 H. pylori-positive subjects were enrolled from 2010 to 2018 and their data were subjected to intention-to-treat (ITT) and per-protocol (PP) analysis. All subjects received 10-day sequential therapy consisting of 40 mg esomeprazole and 1 g amoxicillin b.i.d for 5 days followed by 40 mg esomeprazole b.i.d, 500 mg clarithromycin b.i.d and 500 mg metronidazole t.i.d for 5 days. The 13C-urea breath test, rapid urease test (CLO test®), and histology were used to confirm eradication. Compliance and side effects were also investigated.
Results: ITT and PP eradication rates of SQT were 69.9% (687 of 983) and 87.1% (657 of 754), respectively. The annual eradication rate of ITT remained consistent over the 8-year study period (p for trend=0.167), whereas PP analysis showed the eradication rate increased (p for trend=0.042). The overall adverse event rate for SQT was 41.7% (410 subjects).
Conclusions: Despite high antibiotic resistance rates in Korea, the eradication rate of SQT did not decrease over the 8-year study period.
Keywords: Helicobacter pylori; Sequential therapy; Intention to treat analysis; Per-protocol analysis

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