Prolonged and Profound Acid Inhibition Is Crucial in Helicobacter pylori Treatment with a Proton Pump Inhibitor Combined with Amoxicillin

Background: The aim was to investigate whether intragastric pH, meal-stimulated gastrin release, or demographic factors predict the outcome of Helicobacter pylori treatment. Methods: Thirty-six patients with H. pylori infection were investigated with 24-h intragastric pH registration and meal-stimulated gastrin release before and during treatment with 20 mg omeprazole twice daily and 750 mg amoxicillin twice daily for 14 days. The influence of age, sex, smoking, ethnic origin, pH, and gastrin on treatment outcome were analysed with logistic regression. Results: Eradication of H. pylori was achieved in 18 of 34 (53%) patients. The univariate analysis showed that age, ethnic origin, more than 84.2% of the time with pH above 4, and continuous periods longer than 156 min with intragastric pH above 6 were significantly associated with successful treatment of H. pylori. In the multivariate analysis only the two pH variables were found to be independent factors for predicting treatment outcome. Conclusion: The outcome of H. pylori treatment with omeprazole and amoxicillin may depend on several factors, such as age, ethnic origin, and a pronounced acid suppression. However, the only factor of independent importance in this study was prolonged and profound acid inhibition.