Evaluation of eradication efficacy and optimization strategies for Helicobacter pylori infection based on real-world...

Based on real-world clinical data, this study aims to evaluate the differences in eradication efficacy among various H. pylori treatment regimens and the impact of prescription appropriateness on treatment outcomes.

This single-center retrospective study included 897 patients with confirmed H. pylori infection (September 2022-September 2025). Eradication rates were compared among dual, triple, and bismuth-containing quadruple therapies, stratified by prescription appropriateness per 2022 Chinese guidelines. Multivariable logistic regression and stratified analyses were performed to assess factors associated with eradication success and follow-up adherence.

Overall ITT and PP eradication rates were 79.04 and 90.23%, respectively. Quadruple therapy achieved the highest rates (ITT: 81.42%; PP: 93.76%), outperforming dual and triple therapies. Prescription appropriateness significantly affected eradication in the quadruple therapy group (p < 0.01). In quadruple therapy, female was associated with higher eradication success (OR = 2.53, 95% CI: 1.15-5.73). In the inappropriate dual therapy subgroup, amoxicillin dose (<2.0 g vs. ≥2.0 g/day) did not significantly alter eradication rates. Older patients and those using TCM demonstrated better follow-up compliance.

Clinical practice should prioritize guideline-recommended regimens and standards; however, actual eradication effectiveness may vary depending on the regimen selected. Among these, bismuth-containing quadruple therapy should be the first-line treatment of choice and should be used in strict accordance with guideline standards.