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Preoperative Versus Postoperative Helicobacter pylori Eradication Therapy in Gastric Cancer Patients

A Randomized Trial

Kim, Chan Gyoo, M.D.1; Song, Ho June, M.D.1; Kook, Myeong-Cherl, M.D., Ph.D.1; Hong, Eun Kyung, M.D., Ph.D.1; Park, Sohee, Ph.D.2; Lee, Jong Yeul, M.D.1; Lee, Jun Ho, M.D.1; Ryu, Keun Won, M.D., Ph.D.1; Kim, Young-Woo, M.D. Ph.D.1; Bae, Jae-Moon, M.D., Ph.D.1; Choi, Il Ju, M.D., Ph.D.1

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 48–54
ORIGINAL CONTRIBUTIONS: STOMACH
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OBJECTIVES Helicobacter pylori (H. pylori) eradication is strongly recommended for gastric cancer patients who undergo subtotal gastrectomy. The efficacy of proton pump inhibitor-based triple therapy for H. pylori eradication has not been adequately assessed in the gastric remnant. The aim of this study was to compare the efficacy of postoperative versus preoperative H. pylori eradication therapy.

METHODS A total of 138 distal gastric cancer patients with H. pylori infection were randomized to receive either preoperative (preop, N = 68) or postoperative (postop, N = 70) proton pump inhibitor-based triple therapy for H. pylori eradication. The regimen consisted of rabeprazole 10 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily for 7 days. Eradication was assessed by rapid urease test and histology 12 wk after surgery.

RESULTS By intention-to-treat (ITT) analysis, H. pylori eradication rates were 84.6% (95% CI 73.5–92.4) in the preop group and 83.1% (95% CI 71.7–91.2) in the postop group (P= 0.99). By per protocol (PP) analysis, the rates were 87.3% (95% CI 76.5–94.4) in the preop group and 86.9% (95% CI 75.8–94.2) in the postop group (P= 0.99). In the postop group, eradication rates did not differ with reconstruction method (Billroth I vs II, 80.4% [95% CI 66.1–90.6] vs 89.5% [95% CI 66.9–98.7] by ITT analysis (P= 0.49), and 85.7% [95% CI 71.5–94.6] vs 89.5% (95% CI 66.9–98.7) by PP analysis, P= 0.99).

CONCLUSIONS In distal gastric cancer patients, the effect of proton pump inhibitor-based triple therapy for H. pylori eradication was not different whether given postoperatively or preoperatively.

1Research Institute and Hospital and 2Cancer Biostatistics Branch, National Cancer Center, Goyang, Korea

Reprint requests and correspondence: Il Ju Choi, M.D., Ph.D., Center for Gastric Cancer, National Cancer Center, 809 Madu 1-Dong, Ilsan-Dong Gu, Goyang, Gyeonggi, 411–769, Korea.

[Correction added after online publication 21-Aug-2007. Dr. Park's affiliation has been updated.]

Received April 4, 2007; accepted June 29, 2007.

CONFLICT OF INTERESTGuarantor of the article: Il Ju Choi, M.D., Ph.D.

Specific author contributions: Chan Gyoo Kim: obtaining informed consent, endoscopy, data analysis, drafting the manuscript; Ho June Song: obtaining informed consent, endoscopy, data analysis, drafting of the manuscript; Myeong-Cherl Kook: histological analysis; Eun Kyung Hong: histological analysis; Sohee Park: statistical analysis; Jong Yeul Lee: obtaining informed consent, endoscopy; Jun Ho Lee: surgery and monitoring postoperative complications; Keun Won Ryu: surgery and monitoring postoperative complications; Young-Woo Kim: surgery and monitoring postoperative complications; Jae-Moon Bae: surgery and monitoring postoperative complications; Il Ju Choi: design of the trial, endoscopy, interpretation of the data.

Financial support: This work was supported by grant 0310050 from the National Cancer Center, Korea.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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