Research Article: A comparative study of eradication rates, adverse events, and compliance between triple therapy and bismuth-containing quadruple therapy in children with Helicobacter pylori infection
Abstract:
To compare the eradication efficacy, symptom improvement, and safety between standard triple therapy and bismuth-containing quadruple therapy for Helicobacter pylori ( H. pylori ) infection in children.
This retrospective cohort study included 161 pediatric patients who completed either a 14-day triple therapy (proton pump inhibitor, clarithromycin, amoxicillin; n =?78) or a 14-day bismuth-containing quadruple therapy (adding colloidal bismuth subcitrate; n =?83). The primary outcome was the eradication rate assessed by 13 C-urea breath test 4 weeks post-treatment. Secondary outcomes included changes in abdominal pain, bloating, and nausea scores (measured by a 4-point Likert scale before and after treatment) and the incidence of adverse events.
The eradication rate was significantly higher in the bismuth-containing quadruple therapy group (90.36%) compared to the triple therapy group (74.36%) ( P =?0.007). Post-treatment symptom scores improved more markedly with bismuth-containing quadruple therapy for abdominal pain (0.68 vs. 0.85, P <?0.001), bloating (0.55 vs. 0.64, P =?0.021), and nausea (0.35 vs. 0.41, P =?0.024). In a subgroup analysis restricted to patients with successful eradication, the bismuth-containing quadruple therapy group still had significantly lower abdominal pain scores ( P =?0.002), suggesting a potential independent effect of bismuth on abdominal pain relief. The incidence of adverse events and the medication compliance rate were comparable between the two groups ( P >?0.05). Multivariate analysis identified bismuth-containing quadruple therapy as a protective factor against eradication failure (Adjusted OR?=?0.351, P =?0.018).
Bismuth-containing quadruple therapy is potentially advantageous to standard triple therapy for eradicating H. pylori and alleviating associated symptoms in children, with a similar safety and compliance profile.
Introduction:
Helicobacter pylori ( H. pylori ) infection is a prevalent condition affecting millions of individuals worldwide, including children ( 1 ). This bacterium is a major cause of chronic gastritis, peptic ulcer disease, and gastric cancer. In pediatric populations, H. pylori infection can lead to significant morbidity, impacting growth, nutrition, and overall quality of life. Effective eradication of H. pylori is crucial for preventing these complications and improving long-term health outcomes ( 2 , 3 ). Traditional…
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