Efficacy of Bismuth-Based Quadruple Therapy Compared with Clarithromycin-Based Triple Therapy for Helicobacter pylori Infection in a Predominantly Hispanic Population.

Abstract

Objectives: Helicobacter pylori infection affects approximately 4.4 billion people worldwide, with significant prevalence variations based on geographic location, ethnicity, and socioeconomic factors. This study aimed to compare the effectiveness of bismuth-based quadruple therapy and clarithromycin-based triple therapy in a predominantly Hispanic population along the US-Mexico border and assess the impact of changes in the American College of Gastroenterology guidelines recommendations on the management of H pylori.

Methods: This retrospective cohort study included adult patients treated for H pylori infection between January 2009 and March 2022 at a tertiary care hospital on the US-Mexico border. The inclusion criteria included confirmed H pylori infection, treatment with clarithromycin-based triple therapy or bismuth-based quadruple therapy, and documented eradication testing. The data collected included demographics, treatment details, socioeconomic factors, and eradication outcomes. Statistical analyses included unpaired t tests, χ² tests, and multinomial logistic regression. Relative risk and odds ratios were calculated to evaluate treatment efficacy and associated factors.

Results: Of 5489 patient records reviewed, 936 were included. In adjusted analyses, patients treated with bismuth-based quadruple therapy had higher eradication rates compared with clarithromycin-based triple therapy (91.5% vs 83.3%, relative risk =1.11, 95% confidence interval 1.05-1.17, P < 0.001). Following the 2017 American College of Gastroenterology H pylori guidelines, the use of bismuth quadruple therapy increased significantly (24.6% vs 11.2%, P < 0.001). Socioeconomic factors such as insurance status and educational level were associated with the likelihood of follow-up eradication testing and treatment success.

Conclusions: Bismuth quadruple therapy had higher eradication rates in a predominantly Hispanic population along the US-Mexico border. Insurance status and socioeconomic factors continue to affect treatment access and eradication testing.