Prospective Randomized Trial of Esomeprazole versus Lansoprazole and Omeprazole Based Triple Therapy for H. Pylori Eradication in an Iranian Population

Although triple therapy with one proton pump inhibitor (PPI) and two antibiotics for one week has been introduced as the treatment of choice, quadruple therapy in Iran is the standard treatment due to the organism’s high resistance is related to Helicobacter pylori (H. pylori) organism. Comparison of three different PPIs; esomeprazole, lansoprazole and omeprazole with a longer duration (10 days) for eradication of H. pylori in the Iranian population.Methods and Materials: Two-hundred ninety-four patients with endoscopic evidence of peptic ulcer, non-ulcer dyspepsia, gastritis or acid reflux and confirmed H. pylori, either by histology or a positive urea test were randomly divided into three groups; namely, group I (98 patients) received omeprazole, clarithromycin and amoxicillin (OCA); group II (97 patients) received lansoprazole (LCA) and group III (98 patients) received esomeprazole (NCA) instead of omeprazole.Response to treatment was defined as eradication of H. pylori confirmed by negative C14 urea breath test 40 days after treatment course completion. Per protocol (PP) eradication rate of H. pylori was 91.9 % for group I, 80.4 % for group II and 91.8 % for group III (P = 0.017). Intention to treat (ITT) eradication rate for groups I, II and III were 91 %, 78 % and 90 %, respectively (P = 0.012). The patients’ compliance was 99 %, 97 % and 98 % and the adverse events were 36 %, 35 % and 14 % in these three groups, respectively (P = 0.614) (P = 0.001). Based on age and sex, eradication rate showed significant difference without considering various treatment protocols (P = 0.017 and 0.031, respectively). There was no difference in eradication rate between PUD and NUD patients (P = 0.166). Both PP and ITT eradication rates were higher in the OCA and NCA treatment groups. Group III had the least adverse effects. Eradication by NCA regimen had less side effects but more cost compared to OCA regimen.