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Canadian Journal of Gastroenterology
Volume 27, Issue 12, Pages 701-706
Original Article

A Randomized Controlled Trial Comparing Sequential with Triple Therapy for Helicobacter pylori in an Aboriginal Community in the Canadian North

Amy L Morse,1 Karen J Goodman,1 Rachel Munday,2 Hsiu-Ju Chang,1 John Morse,3 Monika Keelan,4 Janis Geary,1 Sander Veldhuyzen van Zanten,1 and CAN Help Working Group

1Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
2Susie Husky Health Centre, Aklavik, Canada
3Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
4Department of Laboratory Medicine and Pathology, Division of Medical Laboratory Science, University of Alberta, Edmonton, Alberta, Canada

Received 20 July 2013; Accepted 15 September 2013

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.

OBJECTIVE: To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminating H pylori infection in Aklavik.

METHODS: Treatment-naive H pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistant H pylori were randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.

RESULTS: Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.

CONCLUSIONS: While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standard H pylori treatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik.