Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4846
Peer-review started: April 24, 2020
First decision: June 13, 2020
Revised: July 18, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 28, 2020
The Helicobacter pylori (H. pylori) eradication rate is decreasing in the general population of China.
To evaluate the H. pylori eradication status in real-world clinical practice and to explore factors related to eradication failure.
Patients with H. pylori infection who were treated with standard 14-d quadruple therapy and received a test of cure at a provincial medical institution between June 2018 and May 2019 were enrolled. Demographic and clinical data were recorded. Eradication rates were calculated and compared between regimens and subgroups. Multivariate analysis was performed to identify predictors of eradication failure.
Of 2610 patients enrolled, eradication was successful in 1999 (76.6%) patients. Amoxicillin-containing quadruple regimens showed a higher eradication rate than other quadruple therapy regimens (83.0% vs 69.0%, P < 0.001). The quadruple therapy containing amoxicillin plus clarithromycin achieved the highest eradication rate (83.5%). Primary therapy had a higher eradication rate than rescue therapy (78.3% vs 66.5%, P < 0.001). In rescue therapy, the amoxicillin- and furazolidone-containing regimens achieved the highest eradication rate (80.8%). Esomeprazole-containing regimens showed a higher eradication rate than those containing other proton pump inhibitors (81.8% vs 74.9%, P = 0.001). Multivariate regression analysis found that older age, prior therapy, and use of omeprazole or pantoprazole were associated with an increased risk of eradication failure.
The total eradication rate is 76.6%. Amoxicillin-containing regimens are superior to other regimens. Age, prior therapy, and use of omeprazole or pantoprazole are independent risk factors for eradication failure.
Core tip: The Helicobacter pylori eradication rate is decreasing worldwide, and there is a lack of recent data from China. The current study of 14-d quadruple regimens in Eastern China revealed an eradication rate of 76.6%. Amoxicillin-containing regimens had the highest eradication rate in primary therapy, and amoxicillin- and furazolidone-containing regimens showed superiority in rescue therapy. Age, prior therapy, and use of omeprazole or pantoprazole were independent risk factors for eradication failure. This study can improve the choice of antibiotics and proton pump inhibitors and indicates that in clinical practice, attention should be paid to elderly patients and rescue therapy.