Randomized controlled comparison of nitroimidazoles for the eradication of Helicobacter pylori and relief of ulcer‐associated and non‐ulcer dyspepsia

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Abstract
Background: : A combination of omeprazole, clarithromycin and either metronidazole or tinidazole is commonly used for Helicobacter pylori eradication. Metronidazole is considerably cheaper than tinidazole but the two have not previously been compared in a randomized trial.Methods: : One hundred and twenty dyspeptic H. pylori‐positive patients with endoscopically defined peptic ulcer [DU (n = 65), GU (n = 12)] or non‐ulcer dyspepsia (NUD, n = 43) were randomized to receive a 1‐week course of twice daily omeprazole 20 mg, clarithromycin 250 mg and either metronidazole 400 mg (OCM) or tinidazole 500 mg (OCT) in a double‐blind fashion. Eradication of H. pylori, safety and side‐effects of treatment, dyspeptic symptom score and consumption of antisecretory drugs were assessed at 6 weeks and 1 year after treatment.Results: : H. pylori eradication was successfully achieved in 57/60 (95%, ITT analysis) of patients receiving OCT and 58/60 (97%, ITT analysis) receiving OCM. Both regimens had similar side‐effect profiles, which accounted for only one patient withdrawal. All patients remained uninfected (as assessed by 14C‐urea breath test) at 1‐year follow‐up, but major symptom improvements and decreased antisecretory drug use were only seen in patients with DU (P < 0.0001).Conclusions: : Treatment with OCM is as effective as the more expensive OCT at eradicating H. pylori. H. pylori eradication results in long‐term relief of dyspeptic symptoms and reduced antisecretory consumption only in patients with DU, and not in those with NUD.