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Efficacy of Bismuth Therapy in Eradicating Helicobacter pylori in Children-Data From the RENIHp Registry
Gonzalo Botija1, Gonzalo Galicia2, Beatriz Martínez3
1Pediatric Gastroenterology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Insights
Colloidal bismuth subcitrate (CBS) therapy effectively eradicated H. pylori in over 90% of pediatric patients, including those with prior treatment failures. This study highlights CBS as a highly effective option for H. pylori eradication in children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori (H. pylori) infection is a significant global health concern in children.
- Eradication of H. pylori is crucial to prevent long-term complications such as gastritis and peptic ulcers.
- Limited treatment options and increasing antibiotic resistance necessitate evaluation of alternative therapies.
Purpose of the Study:
- To assess the efficacy of colloidal bismuth subcitrate (CBS) for H. pylori eradication in a national pediatric registry.
- To determine the H. pylori eradication rates in children treated with CBS-containing regimens.
- To evaluate CBS efficacy in a pediatric population, including those with prior treatment failures.
Main Methods:
- A national, multi-center, prospective registry (RENIHp) of children aged 5-18 years with H. pylori infection was utilized.
- Patients treated with CBS between 2020-2023 were included, with eradication assessed via 13C-urea breath test or stool antigen.
- Treatment regimens included quadruple therapy with proton pump inhibitors (PPIs), CBS, amoxicillin, and metronidazole (MET), or PPIs, CBS, tetracycline, and MET.
Main Results:
- Of 682 registry patients, 38 (5.6%) received CBS therapy; 50% had prior unsuccessful eradication.
- The overall H. pylori eradication rate with CBS was 93.8% (30/32).
- In patients with dual resistance to clarithromycin and metronidazole, quadruple therapy with CBS achieved a 100% eradication rate (6/6).
Conclusions:
- Colloidal bismuth subcitrate therapies demonstrated high efficacy (>90%) for H. pylori eradication in this pediatric cohort.
- CBS is a highly effective treatment option, even in selected cases with prior treatment failures or antibiotic resistance.
- Further research may explore optimal CBS-based regimens for pediatric H. pylori infections.
Objectives:
To evaluate the efficacy of colloidal bismuth subcitrate (CBS) therapy for the eradication of H. pylori in patients from a national pediatric registry of H. pylori infection.
Methods:
The Spanish Registry of Children with H. pylori Infection (RENIHp) is a national, multi-center, prospective, non-interventional registry that includes children aged 5-18 years with H. pylori infection diagnosed by endoscopy. All patients in the registry who were treated with CBS between the period 2020 and 2023 were included in this study. The primary outcome was the eradication rate, which was assessed using a 13C-urea breath test or monoclonal antigen in the stool 6-8 weeks post-treatment.
Results:
The registry included 682 patients, 38 (5.6%) of whom underwent treatment with CBS. Fifty percent (19/38) of patients had previously undergone unsuccessful eradication treatment. In 78.9% (30/38) of patients, treatment was guided by an antibiotic sensitivity test. In the remaining patients, an empirical approach was employed. The CBS therapies used were as follows: quadruple therapy with proton pump inhibitors (PPIs), CBS, amoxicillin, and metronidazole (MET) [18/38 (47.3%)]; quadruple therapy with PPIs, CBS, tetracycline, and MET [13/38 (34.2%)]; and other therapies [7/38 (18.4%)]. Thirty-two patients (84.2%) treated with CBS were followed-up with eradication monitoring. The overall eradication rate in patients treated with CBS was 93.8% (30/32, [95% CI: 85.4%-100%]), whereas it was 86.7% in patients in the registry who were not on CBS treatment (430/496, [95% CI: 83.3%-89.5%], p = 0.208). In the six patients with dual resistance to clarithromycin (CLA) and MET who were treated with quadruple therapy with CBS, the eradication rate was 100% (n = 6/6, [95% CI: 61.0%-100%]).
Conclusion:
CBS therapies in our registry, although only used in selected cases and at lower than recommended levels, were very effective and showed an eradication rate of > 90%.
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