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Clin Microbiol Infect. 2017 Jun;23(6):391-395. doi: 10.1016/j.cmi.2016.12.032. Epub 2017 Jan 7.

Ten-day bismuth-containing quadruple therapy is effective as first-line therapy for Helicobacter pylori-related chronic gastritis: a prospective randomized study in China.

Author information

1
Department of Gastroenterology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China.
2
Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China; Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
3
Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
4
Department of Gastroenterology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
5
Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
6
Department of Gastroenterology, Central Hospital of Lishui City, Lishui, Zhejiang Province, China.
7
Department of Gastroenterology, Central Hospital of Jinhua City, Jinhua, Zhejiang Province, China.
8
Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China.
9
Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
10
Department of Gastroenterology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
11
Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China; Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China. Electronic address: sijm@zju.edu.cn.

Abstract

OBJECTIVES:

To investigate the effectiveness of 10-day bismuth-containing quadruple (B-quadruple) treatment as first-line therapy in patients with Helicobacter pylori-related chronic gastritis.

METHODS:

A randomized controlled trial was conducted from October 2011 to December 2013 in Zhejiang, China, including patients with H. pylori-related chronic gastritis who were randomly provided either 10-day omeprazole-based triple therapy (OM-triple; omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily) or 10-day B-quadruple therapy (OM-triple + bismuth subcitrate 120 mg four times daily). H. pylori status, pathologic findings and dyspeptic symptoms were assessed at baseline and after 3 months. The primary outcome was H. pylori eradication rates by intention-to-treat (ITT) and per-protocol (PP) analyses. The secondary outcomes were the histologic and symptomatic benefits from H. pylori eradication.

RESULTS:

A total of 351 patients with H. pylori-related chronic gastritis were recruited. The eradication rates of the OM-triple and B-quadruple groups were 58.4% (108/185) and 86.1% (143/166) respectively according to ITT analysis (p <0.01). PP rates of H. pylori eradication were 63.2% (108/171) and 92.3% (143/155) respectively (p <0.01). According to the PP analysis, active and chronic inflammation in gastric mucosa was substantially improved in all treated patients (n=326). However, pathologic atrophic gastritis and intestinal metaplasia did not regress in both groups (n=326). The reduction of dyspeptic symptoms score was significantly higher in the B-quadruple group than in the OM-triple group (0.59±0.057 vs. 0.39±0.046) (p <0.01).

CONCLUSIONS:

Ten-day B-quadruple therapy is more effective than OM-triple therapy as first-line therapy for patients with H. pylori-induced chronic gastritis in China.

KEYWORDS:

Bismuth-containing quadruple therapy; Chronic gastritis; First-line therapy; Helicobacter pylori; Omeprazole-based triple therapy

PMID:
28077338
DOI:
10.1016/j.cmi.2016.12.032
[Indexed for MEDLINE]
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