THE CHALLENGE OF HELICOBACTER PYLORI ERADICATION THERAPIES BASED ON ANTIBIOTIC SUSCEPTIBILITY TESTING IN A HIGHLY SELECTED GROUP OF PANGASTRITIS PATIENTS.

Introduction: Hp eradication continues to be a challenge in a small group of patients. Antibiotic susceptibility testing has been proposed in order to obtain definitive cure but results are controversial. Aim of the study: To verify outcomes of susceptibility testing and eradication therapies in pangastritis patients who underwent at least two previous eradication schedules. Patients and Methods: Thirty seven patients ( 30 women and 7 men, median age of 53 years) with pangastritis and who had already undergone more than two eradication attempts (median 3) were elected for susceptibility testing and eradication therapy. Eight biopsy samples ( 3 antrum, 3 corpus, 2 fundus ) were collected for Hp culture and susceptibility testing and 2 additional samples from each region for histology. Patients with positive cultures, received specific antibiotic therapy while pts with coccoid forms received empiric therapy.C13 Urea Breath test were performed after one month of wash-out period. Variables such as age, BMI, number of eradication therapies, pattern of gastritis distribution, Global Inflammation Score, Hp load, colloidal bismuth based therapies, susceptibility based or empirical therapy were matched with the result of eradication therapy. A descriptive statistical analysis was performed on observed data: frequency distributions were obtained and mean, median and standard deviation were computed on quantitative data. Two-way tables were then created including the variable 'therapeutic outcome' and each observed variable; relation between therapeutic outcome and other variables was assessed by chi square test. A two-tailed p<0.05 was considered statistically significant. Thereafter by logistic stepwise regression analysis the multiple relationship of therapeutic outcome with the other variables was assessed. Results: The culture and susceptibility testing were obtained in 64% of the pts (24/37). In 25%(6/24pts)eradication was successful. Empiric therapeutic schedules provided positive result in 53,8% pts (7/13). The overall eradication rate (negative C13 UBT) was 37%. Among the many variables examined only the presence of pangastritis and corpus predominant gastritis was associated to treatment failure in 80% of pts (12/15)(p<0.05). Conclusions: The probability of Hp eradication in pangastritis pts is very low and antibiotic susceptibility testing fails to improve the success rate of eradication.