Related Experiment Video
Updated: May 24, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Review article: bismuth-based therapy for Helicobacter pylori eradication in children
L Pacifico1, J F Osborn, C Anania
1Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
Insights
Bismuth-based therapies show moderate Helicobacter pylori eradication rates in children, but more research is needed. Further studies are required to confirm efficacy and safety for H. pylori eradication in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Standard triple therapy for H. pylori eradication in children shows declining efficacy.
- Bismuth-based therapy is emerging as an alternative first-line treatment for pediatric H. pylori infections.
Purpose of the Study:
- To review the properties of bismuth salts.
- To summarize evidence on bismuth-based therapy for H. pylori eradication in children.
Main Methods:
- Bibliographical searches conducted in MEDLINE.
- Meta-analysis of efficacy data for bismuth-containing regimens.
Main Results:
- Bismuth monotherapy demonstrated low efficacy.
- Bismuth-based dual therapy achieved 68-73% eradication rates (ITT/PP).
- Triple therapy with bismuth showed 82-86% eradication rates (ITT/PP), with comparative studies ranging from 69-96%.
Conclusions:
- Evidence for bismuth compounds in pediatric H. pylori treatment is inconclusive.
- Need for well-designed, multi-center randomized trials comparing bismuth-based triple therapy with current standards.
- Audited case series with >95% eradication rates (PP) warrant consideration.
Background:
Because of the decrease in the Helicobacter pylori eradication rate after standard triple therapy with a proton pump inhibitor and two antibiotics, bismuth-based therapy has recently been recommended as alternate first-line regimen in children.
Aim:
To comprehensively review the clinical, pharmacologic and microbiologic properties of bismuth salts, and to summarise the evidence for the therapeutic efficacy of bismuth-based therapy for H. pylori eradication in children.
Methods:
Bibliographical searches were performed in MEDLINE. Results on the efficacy of bismuth-containing regimens on H. pylori eradication were combined using the inverse variance method.
Results:
Bismuth monotherapy showed a very low efficacy. Overall, the mean eradication rate with bismuth-based dual therapy was 68% (95% CI, 60-76%) (intention-to-treat analysis-ITT) and 73% (95% CI, 64-81%) (per protocol-PP). In case series, the overall percentages of children with successful eradication for triple therapy containing bismuth were 82% (95% CI, 76-88%) and 86% (95% CI, 80-92%) according to ITT and PP respectively. In comparative studies, H. pylori eradication rates ranged between 69% and 85% according to ITT and between 74% and 96% PP. Side effects included dark stools, urine discoloration, black tongue, burning tongue, and marked darkness of the gums.
Conclusions:
The evidence in favour of bismuth compounds for treating infected children is still not clear. Well-designed, randomised, multi-centre studies of H. pylori eradication trials in children comparing bismuth-based triple therapy with the best available recommended first-line therapies are needed. The evidence obtained from audited case series that produce an eradication rate of >95% on PP analysis should also be considered.
More Related Videos
06:40Quantitative Polymerase Chain Reaction (qPCR)-Based Rapid Diagnosis of Helicobacter pylori Infection and Antibiotic Resistance
Published on: July 28, 2023
04:56Detection of Helicobacter pylori Infection and Antibiotic Resistance via Stool Quantitative Polymerase Chain Reaction Analysis
Published on: May 16, 2025
Related Concept Videos
01:16Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:27Peptic Ulcer
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:26Gastritis II: Pathophysiology
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption