Sequential therapy for helicobacter pylori in elderly patients: Effectiveness, safety and predictors of success

Background: Sequential therapy is one of the most common regimens for H. pylori eradication. The progressive ageing may lead to several problems in the management of H. pylori. Objective: We aimed to assess the effectiveness/safety of sequential therapy in elderly patients and evaluate possible predictive factors of failure. Methods: We retrospecively enrolled 76 patients >65 years old (elderly group) and 69 controls diagnosed of H. pylori by upper endoscopy/histology and a non-invasive test. Patients received 10-day sequential therapy (esomeprazole 40 mg and amoxicillin 1 g for the first 5 days followed by clarithromycin 500 mg plus tinidazole 500 mg, all b.i.d). Comparison between groups was carried out by t-test or 2 test where appropriate. Binomial logistic regression was used to determine factors influencing treatment failure. Results: Eradication was achieved, at Intention-To-Treat analysis, in the 78.9% and 75.4% in the elderly and control group, respectively, and, at Per-Protocol analysis, in the elderly patients in the 81.1% and in controls in the 76.5%, not statistically different. Both groups experienced a similar rate of side effects (27% vs 26.5% p = 1). At univariate analysis, treatment failure in the elderly group positively correlated with female sex (OR=22.5), side effects (OR=5.3), intestinal metaplasia (OR=6.7) and gastric atrophy (OR=6.8), while negatively with antritis (OR=0.15). However, at multivariate analysis, none of the cited variables was found statistically significant. Conclusion: Sequential therapy is safe in old patients and has satisfactory effectiveness, but an "a priori" model predicting the outcome based only on clinical data is not reliable.