Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1059
Peer-review started: October 18, 2016
First decision: October 28, 2016
Revised: November 21, 2016
Accepted: January 18, 2017
Article in press: January 18, 2017
Published online: February 14, 2017
To investigate Helicobacter pylori (H. pylori) eradication rates using second-line bismuth-containing quadruple therapy and to identify predictors of eradication failure.
This study included 636 patients who failed first-line triple therapy and received 7 d of bismuth-containing quadruple therapy between January 2005 and December 2015. We retrospectively demonstrated H. pylori eradication rates with respect to the year of therapy as well as demographic and clinical factors. H. pylori eradication was confirmed by a 13C-urea breath test or a rapid urease test at least 4 wk after the completion of bismuth-based quadruple therapy: proton pump inhibitor, metronidazole, bismuth, and tetracycline.
The overall eradication rates by intention-to-treat analysis and per-protocol analysis were 73.9% (95%CI: 70.1%-77.4%) and 94.5% (95%CI: 92.4%-96.5%), respectively. Annual eradication rates from 2005 to 2015 were 100.0%, 92.9%, 100.0%, 100.0%, 100.0%, 97.4%, 100.0%, 93.8%, 84.4%, 98.9%, and 92.5%, respectively, by per-protocol analysis. A multivariate analysis showed that diabetes mellitus (OR = 3.99, 95%CI: 1.56-10.20, P = 0.004) was associated with H. pylori eradication therapy failure.
The second-line bismuth-containing quadruple therapy for H. pylori infection is still effective in Korea, and diabetes mellitus is suggested to be a risk factor for eradication failure.
Core tip: This study investigated the efficacy of 7 d of second-line bismuth-containing quadruple therapy for Helicobacter pylori (H. pylori) infection and identified risk factors for eradication failure in South Korea. The overall eradication rate per-protocol analysis was 94.5% in the current study. Additionally, diabetes mellitus was related to H. pylori eradication therapy failure. Therefore, second-line bismuth-containing quadruple therapy for H. pylori infection is still worth considering in South Korea, and diabetes mellitus is suggested to be a risk factor for eradication failure.