Adding Bismuth to Rabeprazole-Based First-Line Triple Therapy Does Not Improve the Eradication of Helicobacter pylori

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pharmacology

Background:

• Helicobacter pylori infection is a global health concern requiring effective eradication therapies.
• Standard first-line triple therapy regimens face challenges with varying eradication rates.
• Bismuth-containing regimens are explored as potential alternatives or adjuncts to improve treatment outcomes.

Purpose of the Study:

• To evaluate the efficacy of adding bismuth subcitrate to a standard 7-day triple therapy (rabeprazole, amoxicillin, clarithromycin) for H. pylori eradication.
• To compare the eradication rates between the standard triple therapy (RAK) and bismuth plus triple therapy (RBAK) groups.
• To assess the safety and tolerability of the RBAK regimen.

Main Methods:

• A randomized controlled trial involving 162 patients with H. pylori infection.
• Patients were assigned to either a 7-day RAK regimen or a 7-day RBAK regimen (RAK + bismuth subcitrate).
• Treatment efficacy was confirmed by endoscopy or urea breath test at least 4 weeks post-treatment.

Main Results:

• No significant difference in H. pylori eradication rates between the RAK (72.8% ITT) and RBAK (77.8% ITT) groups (p=0.47).
• Per-protocol analysis showed similar non-significant differences (RAK 74.7% vs. RBAK 81.8%; p=0.26).
• Adverse effects were common (50.6% in both groups) but rarely led to treatment discontinuation.

Conclusions:

• Adding bismuth to the standard 7-day triple therapy did not substantially improve H. pylori eradication rates.
• The current 7-day RBAK regimen demonstrates comparable efficacy and safety to the standard RAK regimen.
• Further investigation into extended durations (10-14 days) of bismuth-containing regimens is warranted.