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Bismuth-Based quintuple therapy: a step beyond quadruple regimens in H. Pylori treatment and the impact of patient compliance

Dertli R, Asıl M, Atayan Y, Coşar U, Yolaçan R, Bıyık M, Keskin M

BMC gastroenterology, 2025

611 participants · 1 citation

Abstract

Background: Helicobacter pylori (H. pylori) infection is one of the most common infections affecting humanity. As the level of development and socio-economic status of countries decreases, the prevalence of H. pylori infection increases. Although numerous H. pylori eradication regimens have been tested in recent years, the desired level of eradication success has not been achieved. In this study, we aimed to evaluate the effectiveness of alternative treatment protocols.

Methods: Patients who presented to our clinic between 2023 and 2024 were included in the study. The patient groups were treated with Rabeprazole (R), Metronidazole (M), Amoxicillin (A), and Bismuth (B) (RMAB), or with Esomeprazole (E), Metronidazole (M), Tetracycline (T), and Bismuth (B) (EMTB) regimens. Patients who were resistant to both RMAB and EMTB treatment protocols received quintuple therapy with RTAMB and ETAMB. All patients were thoroughly informed about their treatment process, management of side effects, and adherence to the therapy.

Results: A total of 611 patients who received H. pylori treatment were included in the study. Of the participants, 60.7% were women, and the mean age was 53.7 ± 15.2 years. For post-treatment response evaluation, 73.5% (n = 449) of the patients returned to our clinic. The overall H. pylori eradication success rate for the entire patient group was 49.6%. The success rates for patients receiving RMAB and EMTB treatments were 48.2% and 51.3%, respectively. Among the…

How strong is the evidence?

Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 611 participants or records.

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