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.