Bismuth-based quadruple therapy vs concomitant therapy for Helicobacter pylori eradication—a real-world experience

Abstract

Background and Aims

Both bismuth-based quadruple therapy (BQT) and concomitant therapy (CCT) are first-line regimens for Helicobacter pylori eradication. We compared the efficacy and adverse effects of both regimens in day-to-day clinical practice.

Methods

Adult patients with biopsy-proven H. pylori infection were included. Drug therapy was based on patient and physician preference. Both BQT and CCT regimens were given for 14 days. Efficacy was assessed using a stool antigen for H. pylori 4 weeks after treatment.

Results

One hundred and twenty-nine consecutive patients were analysed, and the demographic characteristics of the two groups were similar. Treatment compliance was comparable in both regimens (P = 0.074), and 12/81 (14.8%) and 3/48 (12.5%) defaulted in BQT and CCT groups, respectively. 64.2% and 48% of patients reported some adverse effect in BQT and CCT groups (P = 0.10). Predominant adverse effects reported were nausea (41.9% vs 25%), black stools (29.6% vs 2%), vomiting (24.7% vs 6.25%) and loose stools (9.8% vs 20.8%) in BQT and CCT groups. Treatment efficacy of BQT and CCT regimen by intention-to-treat analysis was 87.7% (n = 71/81) and 79.2% (n = 38/48) (P = 0.321) and by per-protocol was 89.9% (n = 62/69) and 82.2% (n = 37/45) (P = 0.37).

Conclusion

Treatment efficacy with BQT is equivalent to CCT for H. pylori eradication. Both regimens have similar compliance rates, adverse events and affordability. With rising antibiotic resistance, BQT should be considered a better first-line option for H. pylori eradication.