Esophagus to Small Intestine

Gut. 2023;72(11):2031–7

Pérez-Aisa Á, Nyssen OP, Keco-Huerga A, Rodrigo L, Lucendo AJ, Gomez-Rodriguez BJ, Ortuño J, Perona M, Huguet JM, Núñez O, Fernandez-Salazar L, Barrio J, Lanas A, Iyo E, Romero PM, Fernández-Bermejo M, Gomez B, Garre A, Gomez-Camarero J, Lamuela LJ, Campillo A, de la Peña-Negro L, Dominguez Cajal M, Bujanda L, Burgos-Santamaría D, Bermejo F, González-Carrera V, Pajares R, Almela Notari P, Tejedor-Tejada J, Planella M, Jiménez I, Arguedas Lázaro Y, Cuadrado-Lavín A, Pérez-Martínez I, Amorena E, Gonzalez-Santiago JM, Angueira T, Flores V, Martínez-Domínguez SJ, Pabón-Carrasco M, Velayos B, Algaba A, Ramírez C, Alfaro Almajano E, Castro-Fernandez M, Alcaide N, Sanz Segura P, Cano-Català A, García-Morales N, Moreira L, Mégraud F, O’Morain C, Calvet X, Gisbert JP

Bismuth quadruple three-in-one single capsule 3 times a day increases effectiveness compared with the usual 4 times a day schedule: Results from the European Registry on Helicobacter pylori Management (Hp-EuReg)

Background: The recommended schedule for single capsule bismuth quadruple therapy (scBQT) includes a proton-pump inhibitor (PPI) 2 times a day and 3 scBQT capsules 4 times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with 3 times a day schedules. In clinical practice, many gastroenterologists use 4 capsule scBQT 3 times a day. However, the effectiveness and safety of this latter approach remain uncertain.
Aim: To assess the effectiveness and safety of scBQT administered 3 times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg).
Methods: All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analyzed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given 3 times a day were calculated and compared with the 4 times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection.
Results: Of the 3712 cases, 2516 (68%) were 4 times a day and 1196 (32%) 3 times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The 3 times a day schedule showed significantly better overall cure rates than 4 times a day (1047/1112, 94%; 95% confidence interval [CI]: 92.7–95.6 vs. 2207/2423, 91%; 95% CI: 89.9–92.2, respectively, p = 0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, 3 times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection.

Conclusions: Single capsule bismuth quadruple therapy (scBQT) prescribed 3 times a day was more effective than the traditional 4 times a day schedule. No differences were observed in treatment adherence or safety.

Prof. Dr. X. Calvet, Servei d’Aparell Digestiu, Departament de Medicina, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain, E-Mail:

DOI: 10.1136/gutjnl-2022-329259

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