Introduction
Helicobacter pylori (H. pylori) infection remains a major public health problem. Given the high resistance to antibiotics worldwide, quadruple therapies have emerged as a major therapeutic option with unclear long-term consequences.
Aims & Methods
To evaluate if quadruple therapies determine major changes in the immunological profile of patients submitted to H. pylori eradication.
All patients were submitted to eradication treatment with five quadruple therapies (A-Concomitant with metronidazole 500mg tid, 14 days; B-Concomitant with metronidazole 500mg bid, 14 days; C-Quadruple with bismuth, 10 days; D-Sequential, 14 days; E-Hybrid, 14 days)) in a blind, randomized trial. Esomeprazole was the proton-pump inhibitor of choice. Efficacy and safety rates after 2 and 12 months of treatment were evaluated. Analysis of immunological changes included cell populations study by flow cytometry (CD4+, CD8+, B-cell, T-cell, natural killer cells and CD4+/CD8+-cells ratio).
Results
One-hundred-twenty-six patients (42.9% males; mean age: 57.4±16.7 years) completed the protocol. Overall efficacy and adverse events rates were 98.4% and 47.6%, respectively. After treatment, 36 patients (28.6%) developed other infectious diseases (mean time: 9.5±5.7 months), being severe (need for hospitalization) in 3 patients (8.3%). Comparing the post-treatment infection/non-infection groups, there was a significant decrease in the B-cell count (Z(2,52)=3.5;p=0.037). Regarding severe infections, there was a decrease in the CD4+/CD8+-cells ratio, CD4+ and B-cell counts (Z(2,52)=59.9,p<0.001; Z(2,52)=5.9,p=0.005 and Z(2,52)=12.0,p<0.001, respectively) and an increase in the CD8+ count (Z(2,52)=5.6;p=0.006). Considering the different regimens used, a significant decrease in the CD4+/CD8+-cells ratio was verified for regimen C compared to other non-bismuth quadruple therapies (Z(1.4,35.2)=5.2,p=0.019).
Conclusion
Quadruple therapies are highly effective in eradicating H. pylori gastric infection. However, these therapies are associated with adverse events, with infections occurring in ~1/4 of patients. There is a significant decrease in the CD4+/CD8+-cells ratio and B-cell count for all treatments, most significantly in the CD4+/CD8+-cells ratio for bismuth-containing regimen.
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Disclosure
None of the authors have anything to declare with regard to personal or financial interests in carrying out this work.