Efficacy of Bismuth-Based Quadruple Therapy Compared with Clarithromycin-Based Triple Therapy for Helicobacter pylori...

Helicobacter pylori infection affects approximately 4.4 billion people worldwide, with significant prevalence variations based on geographic location, ethnicity, and socioeconomic factors. This study aimed to compare the effectiveness of bismuth-based quadruple therapy and clarithromycin-based triple therapy in a predominantly Hispanic population along the US-Mexico border and assess the impact of changes in the American College of Gastroenterology guidelines recommendations on the management of H pylori.

This retrospective cohort study included adult patients treated for H pylori infection between January 2009 and March 2022 at a tertiary care hospital on the US-Mexico border. The inclusion criteria included confirmed H pylori infection, treatment with clarithromycin-based triple therapy or bismuth-based quadruple therapy, and documented eradication testing. The data collected included demographics, treatment details, socioeconomic factors, and eradication outcomes. Statistical analyses included unpaired t tests, χ² tests, and multinomial logistic regression. Relative risk and odds ratios were calculated to evaluate treatment efficacy and associated factors.

Of 5489 patient records reviewed, 936 were included. In adjusted analyses, patients treated with bismuth-based quadruple therapy had higher eradication rates compared with clarithromycin-based triple therapy (91.5% vs 83.3%, relative risk =1.11, 95% confidence interval 1.05-1.17, P < 0.001). Following the 2017 American College of Gastroenterology H pylori guidelines, the use of bismuth quadruple therapy increased significantly (24.6% vs 11.2%, P < 0.001). Socioeconomic factors such as insurance status and educational level were associated with the likelihood of follow-up eradication testing and treatment success.

Bismuth quadruple therapy had higher eradication rates in a predominantly Hispanic population along the US-Mexico border. Insurance status and socioeconomic factors continue to affect treatment access and eradication testing.