Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Jan;18(1):89-98.
doi: 10.1016/j.cgh.2019.03.048. Epub 2019 Apr 10.

Combination of Bismuth and Standard Triple Therapy Eradicates Helicobacter pylori Infection in More than 90% of Patients

Adrian G McNicholl  1 , Dmitry S Bordin  2 , Alfredo Lucendo  3 , Galina Fadeenko  4 , Manuel Castro Fernandez  5 , Irina Voynovan  6 , Natalia Valerievna Zakharova  7 , Aiman Silkanovna Sarsenbaeva  8 , Luis Bujanda  9 , Ángeles Perez-Aisa  10 , Liudmila Vologzhanina  11 , Oleg Zaytsev  12 , Tatiana Ilchishina  13 , Cristobal de la Coba  14 , Jorge Perez Lasala  15 , Sergey Alekseenko  16 , Ines Modolell  17 , Javier Molina-Infante  18 , Rafael Ruiz-Zorrilla Lopez  19 , Horacio Alonso-Galan  9 , Nuria Fernandez Moreno  10 , Jen Hinojosa  10 , Inmaculada Santaella  10 , Pilar Varela  14 , Pedro Luis Gonzalez-Cordero  18 , Jesus Barrio  20 , Jose Luis Dominguez-Jimenez  21 , Oscar Nuñez  22 , Javier Alcedo  23 , Olga P Nyssen  1 , Maria Caldas  1 , Maria G Donday  1 , Oleg Shvetz  24 , Francis Megraud  25 , Colm O'Morain  26 , Javier P Gisbert  27
Affiliations
Multicenter Study

Combination of Bismuth and Standard Triple Therapy Eradicates Helicobacter pylori Infection in More than 90% of Patients

Adrian G McNicholl et al. Clin Gastroenterol Hepatol. 2020 Jan.

Abstract

Background & aims: Due to the poor eradication rates of standard triple therapy, the addition of bismuth salts has been proposed for first-line eradication of Helicobacter pylori. We assessed the effectiveness and safety of the combination of bismuth and the standard, clarithromycin-containing triple therapy in eradication of H pylori infection, using data from a large multi-center registry.

Methods: We performed an interim analysis of data from the European Registry on H pylori Management, a prospective trial registering clinical data and outcomes from infected patients from 27 countries in Europe since 2013. We extracted data on 1141 treatment-naïve patients who received first-line treatment with bismuth salts (240 mg) and a proton pump inhibitor (57% received esomeprazole, 18% received omeprazole, 11% received pantoprazole, and 14% received rabeprazole), amoxicillin (1 g), and clarithromycin (500 mg), all taken twice daily.

Results: Intention to treat and per-protocol rates of eradication were 88% and 94%, respectively. Intention to treat eradication increased to 93% in patients who received 14-day treatments. Adverse events occurred in 36% of patients; 76% of these events were mild, with a mean duration of 6 days. In multivariate analysis, eradication was associated with treatment compliance (odds ratio [OR], 13.0), a double dose (equivalent to 40 mg omeprazole) of proton pump inhibitor (OR, 4.7), and 14-day duration of treatment (OR, 2.0).

Conclusions: In an analysis of data from a large multi-center registry, we found the addition of bismuth to 14-day standard triple therapy with clarithromycin and amoxicillin to eradicate H pylori infection in more than 90% of patients, based on intention to treat analysis, with an acceptable safety profile and level of adherence. ClinicalTrials.gov no: NCT02328131.

Keywords: Antimicrobial; Bacteria; Database; Hp-EuReg; Optimized Treatment; PPI.

PubMed Disclaimer

Comment in

  • Reply.
    Mcnicholl AG, Gisbert JP. Mcnicholl AG, et al. Clin Gastroenterol Hepatol. 2019 Dec;17(13):2822-2823. doi: 10.1016/j.cgh.2019.05.054. Clin Gastroenterol Hepatol. 2019. PMID: 31757363 No abstract available.
  • Addition of Bismuth to the Standard Triple Therapy for Helicobacter Pylori Infection.
    Ponzetto A, Riva P, Ciancio A. Ponzetto A, et al. Clin Gastroenterol Hepatol. 2019 Dec;17(13):2822. doi: 10.1016/j.cgh.2019.05.036. Clin Gastroenterol Hepatol. 2019. PMID: 31757364 No abstract available.

Publication types

MeSH terms

Associated data