Key Words: helicobacter pylori; patient satisfaction; eradication therapy; telephone survey

Because the Helicobacter pylori (Hp) infection has been the most seen infection in the world, many research studies have been conducted to find an effective therapy regimen for eradication. Long-term regimens are being replaced by short term regimens because the long-term therapies have been found to cause more side effects and drug adjustment of patients is more difficult.
In developing countries like Turkey, Hp infection is more common (1). Because of the difficulties of drug maladjustment of patients, ineffective antibiotics, and common usage of antibiotics, it becomes much more difficult to eradicate Hp in developing countries. The effectiveness of a therapy can be shown not only by the eradication and side effect rate, but also by patient satisfaction.
In this study, we aimed to determine (a) an effective short-term therapy regimen that can be used by a developing country and (b) patient satisfaction with our therapy by following up with a telephone survey 18 months after eradication.

We chose patients with upper gastrointestinal system complaints, who had sought treatment at gastroenterology day clinics at the Ankara Numune Research and Practice Hospital during the period of December 1998-July 1999. In our study, we accepted patients who had been cured by earlier treatment, but who still had some complaints. We also accepted patients, who repeated their earlier treatments once more. After getting information about the study, oral informed consent was taken for each patient and they were assessed physically, clinically, and through laboratory findings. We only accepted patients, who had no other systemic symptoms or disorders. Any drugs they had been taking were stopped at least 15 days before the endoscopic assessment.

They were subjected to endoscopy after a 12-hour period without food. Before the examination, endotracheal Jetocaine was applied for 4 minutes. A Pentax FG29X flexible gastroscope was used. During the endoscopy, at least two specimens were taken from the antrum, corpus and fundus of the stomach. Biopsy specimens were taken for histological and urease tests, and within a half hour, those biopsy specimens, which were placed in a 70% alcohol solution, reached the pathology laboratory The biopsy specimens were painted with a Hemotoxylene- Eosine strain. One month after the therapy, all of these applications were repeated.

We applied a regimen consisting of a five-day-therapy of lansoprasole (30mg bid), a two-day-therapy of tribismuthsubsitrate (300mg qid), amoxicilin (1gram bid), and ornidazole (500mg bid) with lansoprasole. The patients were reassessed one month after treatment. A telephone survey was conducted at the 18th month after eradication and patients, who were treated successfully, were called 18 months after the treatment and asked if they had upper gastrointestinal system complaints after our treatment and if they had been retreated.

42 patients were enrolled in this study. Four patients indicated that they felt fine and did not need to repeat the endoscopic examination. Three patients had stopped the regimen because of side effects. Eradication was successful in 31 out of 35 patients (88.61%). Ulcers were seen in 11 (31.43%) patients, whose upper gastrointestinal system complaints had been completely eradicated after the therapy (eradication rate was 100%). In non-ulcer patients, the eradication rate for their upper gastrointestinal system complaints was 83.33% (20/24 patients). Table 1 shows the distribution of patients.

All the patients reported that their complaints were improved after the therapy.

Eighteen months after the therapy, 31 patients were called again to determine both the effectiveness of our therapy and patient satisfaction. We were able to reach 26 patients. Among those, 18 had no complaints and had not required additional treatment. Eight patients stated that they had the same upper gastrointestinal system complaints and only two of them reported that these were the same as they had prior to the treatment and because of this they needed to use the same drugs again once (Table 2). Only five of the 26 patients needed to use drugs again (Table 3) and two of them stated that they had the same complaints after they underwent surgery for other reasons and parenteral H2 receptor blocker were prescribed for them. The remaining three patients reported that they used the same regimen once more and after the second application they had no complaint.

Since discovery of Hp, many research studies have been conducted to detect its connection with chronic gastritis, duodenal ulcer, gastric ulcer, and adenocarcinoma (2,3,4). These observations have led researchers to conduct therapeutic investigations. Although the Hp microorganism is sensitive to antibiotics invitro, it is too difficult to eradicate in vivo.

As Hp is a true pathogen, there is an increasing inclination in the world to treat all Hp positive patients(5). Many therapy regimens have been tried. Among these, the eradication rates of monotherapies vary from 0 to 44%, whereas combined therapies have eradication rates from 33 to 94%(6,7). Although the two-week-triple therapy regimen is the most accepted, patients experience side effects, which is the major disadvantage. Nowadays, researchers try to find new therapy regimens with fewer side effects and ones that do not affect the patient's ability to think and speak clearly.

Amoxicillin, bismuth, and ornidazole are found effective in different combinations. By adding PPI, an antiasidic environment is provided, and bactericidal effectiveness is increased. Lansoprazole has 4 to 10 times more antihelicobacteric effect and performs acid suppression more quickly. When given two times daily, the 24-hour medium gastric pH increased. Furthermore, it relieves symptoms more quickly than omeprazole. It also reduces the risk of gastrointestinal bleeding(8,9).

In a 7-day-therapy regimen, eradication rates are greater than 90%(10). De Boer et al, recommend that there is no need to continue. In these regimens and in the quadruple regimens, side effect rates are 2.8%. Houben et al, make a comparison of these regimens and find that the eradication rate of bismuth-dependence after one or two weeks was less than 80% (11). In another study, a four-day quadruple regimen rate is 94% in a well-developed country (12). Our eradication rate was lower, and we thought that the main reason is that in developing countries infection and bacterial resistance are higher than in developed countries. In another study that was held in Italy, a two-day-quadruple therapy regimen is applied, and the eradication rate is 84% (13). It is much closer to our results and more successful in ulcer patients, as in our study.

Also there are some limitations of our study. We searched if our patients were satisfied with the therapy rather than the absence of Hp at the 18th month. Further investigations in this field should be done to determine the existence of Hp a long period of time after a therapy regimen.

Our treatment for eradicating Hp, especially in patients who have ulcers, is beneficial for both the patient and society(14). We recommend that all patients, who have a history similar to our patients, should be identified for Hp and treated.

As the main goal of the therapy of peptic ulcer disease is to eradicate Hp which will decrease the recurrence rate of ulcers (15), we think that we reached this goal by this regimen.

Our results at the eighteenth month supported our first results. Our study shows that our regimen was an effective one also from the viewpoint of the patients. Our regimen appears to relieve symptoms for a long time so it can be considered as a successful treatment plan. We suggest that short-term treatment is effective, causes less side effects, and results in more coherent and satisfied patients.