Digestive Diseases and Sciences

, Volume 43, Issue 2, pp 235–240 | Cite as

Augmented Eradication Rates of Helicobacter pylori by New Combination Therapy with Lansoprazole, Amoxicillin, and Rebamipide

  • K. B. Hahm
  • K. J. Lee
  • Y. S. Kim
  • J. H. Kim
  • S. W. Cho
  • H. Yim
  • H. J. Joo


The aim of the present study was to determinethe efficacy of a new combination regimen including anantioxidant, a proton pump inhibitor, and antibioticsagainst Helicobacter pylori and to document the changes of oxidative stress and cytokinesinvolved in H. pylori-associated gastric inflammation.From 57 patients with endoscopically diagnosed gastricand/or duodenal ulcers associated with H. pylori infection five gastric antral biopsy specimenswere taken for the diagnosis of H. pylori and for theexperimental measures. The patients were then treatedeither with lansoprazole 30 mg + amoxicillin 1.5 g (LAgroup; 21 patients) or lansoprazole 30 mg amoxicillin1.5 g + rebamipide 300 mg (LAM group; 36 patients) fortwo weeks. Four weeks after the initiation of treatment,the patients were endoscoped again and biopsy specimens were obtained. Mucosalmalondialdehyde (MDA) levels; myeloperoxidase (MPO)activities; superoxide dismutase; catalase; glutathioneperoxidase; cytokines IL-1, IL-6, TNF-α; andchemokines IL-8, GRO-α, RANTES (regulated onactivation normal T expressed and secreted) weremeasured. Using paraffin-embedded tissue sections, insitu terminal deoxyribonucleotide transferase (TdT)mediated dUTP nick end labeling (TUNEL) for apoptosisand immunohistochemical staining for inducible nitricoxide synthase (iNOS) were performed. Two weeks oftreatment with the LA regimen resulted in 57.4%eradication rates of H. pylori, whereas two weeks oftreatment with the LAM regimen resulted in 75.0%eradication rates. Eradication rates between these twogroups were statistically significantly different (P< 0.05). Mucosal MDA levels and MPO activities weresignificantly lower in the LAM group than the LA group.Mucosal levels of cytokines IL-1, IL-6, and TNF-αand of chemokines IL-8, GRO-α, and RANTES were all significantly decreased after the treatmentof H. pylori, especially so in the LAM group. Theapoptotic index and iNOS score were significantlyreduced after the eradication of H. pylori. The addition of an antioxidative drug to the eradicationregimen against H. pylori has advantages either inaugmenting the eradication rates of H. pylori or indecreasing the oxidative stress and cytokines levelsgenerated by H. pylori infection.



Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Axon ATR, Moayyedi P: Eradication of Helicobacter pylori:Omeprazole in combination with antibiotics. Scand J Gastroenterol Suppl 215:82- 89, 1996Google Scholar
  2. 2.
    Lee A: Prevention of Helicobacter pyloriinfection. Scand J Gastroenterol Suppl 215:11- 15, 1996Google Scholar
  3. 3.
    Unge P, Gad A, Eriksson K, Bergman B, Carling L, Ekstrom P: Amoxicillin added to omeprazole prevents relapse in the treatment of duodenal ulcer patients. Eur J Gastroenterol Hepatol 5:325- 332, 1993Google Scholar
  4. 4.
    Hahm KB, Park IS, Kim YS, Kim JH, Cho SW, Lee SI, Youn JK: Role of rebamipide on induction of heat shock proteins and protection against reactive oxygen metabolite-mediated cell damages in cultured gastric mucosal cells. Free Radic Biol Med 22:711- 716, 1997Google Scholar
  5. 5.
    Takeuchi K, Takehara K, Ohuch T: Diethyl dithiocarbamate, a superoxide dismutase inhibitor, reduces indomethacin-induced gastric lesions in rats. Digestion 57:201- 209, 1996Google Scholar
  6. 6.
    Han B, Kim H, Rhee K, Han H, Chung M: Effects of rebamipide on gastric cell damage by Helicobacter pylori-stimulated human neutrophils. Pharmacol Res 32:201- 207, 1995Google Scholar
  7. 7.
    Davies GR, Simmonds NJ, Stevens TRJ, Sheaff MT, Banatvala N, Laurenson IF, Blake DR, Rampton DS: Helicobacter pyloristimulates antral mucosal reactive oxygen metabolite production in vivo.Gut 35:179 - 185, 1994Google Scholar
  8. 8.
    Baik S, Youn H, Chung M, Lee W, Cho M, Ko G, Park C, Kasai H, Rhee K: Increased oxidative DNA damage in Helicobacter pylori-infected human gastric mucosa. Cancer Res 56:1279 - 1282, 1996Google Scholar
  9. 9.
    Ohkawa H, Ohishi N, Yagi K: Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem 95:351-358, 1979Google Scholar
  10. 10.
    Bradley PP, Priebat DA, Christensen RD, Rothstein G: Measurement of neutrophil content with an enzyme marker. J Invest Dermatol 78:206-209, 1982Google Scholar
  11. 11.
    Claiborne A: Catalase activity. InCRC Handbook of Methods for Oxygen Radical Research. RA Greenwald (ed). Boca Raton, Florida, CRC Press, 1986, pp 283- 284Google Scholar
  12. 12.
    Delmaestra RF, McDonald W: Oxidative enzyme in tissue homogenate. InCRC Handbook of Methods for Oxygen Radical Research. RA Greenwald (ed). Boca Raton, Florida, CRC Press. 1985, pp 291- 296Google Scholar
  13. 13.
    Misra HP, Fridovich I: The role of superoxide anion in the autoxidation of epinephrine and a simple assay for superoxide dismutase. J Biol Chem 247:3170 - 3175, 1972Google Scholar
  14. 14.
    Moran AP: Pathogenic properties of Helicobacter pylori.Scand J Gastroenterol 215;22- 31, 1996Google Scholar
  15. 15.
    Mannick EE, Bravo LE, Zarama G, Realpe JL, Zhang XJ, Ruit B, Fontham ETH, Mera R, Miller MJS, Correa P: Inducible nitric oxide synthase, nitrotyrosine, and apoptosis in Helicobacter pylorigastritis: Effect of antibiotics and antioxidants. Cancer Res 56:3238 - 3243, 1996Google Scholar
  16. 16.
    Harris PR, Mobley HLT, Perez-Perez GI, Blaser MJ, Smith PD: Helicobacter pyloriurease is a potent stimulus of mononuclear phagocyte activation and inflammatory cytokine production. Gastroenterology 111:419 - 425, 1996Google Scholar
  17. 17.
    Moss SF, Legon S, Davies J, Calam J: Cytokine gene expression in Helicobacter pyloriassociated antral gastritis. Gut 35:1567- 1570, 1994Google Scholar
  18. 18.
    Gionchetti P, Vaira D, Campieri M, Holton J, Menegatti M, Belluzzi A, Bertinelli E, Ferretti M, Brignola C, Miglioli M, Barbara L: Enhance d mucosal interleukin-6 and-8 in Helicobacter pylori-positive dyspeptic patients. Am J Gastroenterol 89:883- 887, 1994Google Scholar
  19. 19.
    Crabtree JE: Immune and inflammatory responses to Helicobacter pyloriinfection. Scand J Gastroenterol 215:3- 10, 1996Google Scholar
  20. 20.
    Hahm KB, Lee KJ, Kim YJ, Kim JH, Cho SW, Park SJ, Chung MH: Oxidative DNA damage and apoptosis in Helicobacter pyloriinfection might contribute to gastric carcinogenesis. Gastroente rology 112:A573, 1997Google Scholar
  21. 21.
    Unge P, Berstad A: Pooled analysis of anti-Helicobacter pyloritreatment regimen. Scand J Gastroenterol Suppl 220:27- 40, 1996Google Scholar
  22. 22.
    Unge P: Review of Helicobacter pylorieradication regimens. Scand J Gastroenterol Suppl 215:74 - 81, 1996Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • K. B. Hahm
  • K. J. Lee
  • Y. S. Kim
  • J. H. Kim
  • S. W. Cho
  • H. Yim
  • H. J. Joo

There are no affiliations available

Personalised recommendations