title: Standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori eradication.
abstract: OBJECTIVE
  To compare the effectiveness of standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori (H. pylori) eradication in a randomized, double-blinded, comparative clinical trial in China.
  
  
  METHODS
  A total of 215 H. pylori-positive patients were enrolled in the study and randomly allocated into three groups: group A (n = 72) received a 10-d bismuth pectin quadruple therapy (20 mg rabeprazole bid, 1000 mg amoxicillin bid, 100 mg bismuth pectin qid, and 500 mg levofloxacin qd); group B (n = 72) received the sequential therapy (20 mg omeprazole bid, 1000 mg amoxicillin bid, in 5 d, followed by 20 mg omeprazole bid, 500 mg tinidazole bid, 500 mg clarithromycin bid, for another 5 d); group C (n = 71) received a standard 1-wk triple therapy (20 mg omeprazole bid, 1000 mg amoxicillin bid, 500 mg clarithromycin bid). After all these treatments, 20 mg omeprazole bid was administrated for 3 wk. H. pylori status was assessed by histology, 13C-urea breath test and rapid urease test at baseline and 4-6 wk after completion of treatment. Ulcer cicatrization was assessed by gastroscopy. chi(2) test (P < 0.05) was used to compare the eradication rates and ulcer cicatrisation rates among the three groups.
  
  
  RESULTS
  The eradication rate was 83.33% (60/72) in group A, 88.89% (64/72) in group B, and 80.56% (58/71) in group C. The ulcer cicatrisation rate was 86.44% (51/59) in group A, 90.16% (55/61) in group B, and 84.91% (45/53) in group C. The sequential therapy yielded a higher eradication rate and ulcer cicatrisation rate than the standard triple and bismuth pectin quadruple therapies. Statistically, the eradication rate of group B was significantly different from groups A and C (P < 0.05), but the difference of ulcer cicatrisation rate and side effects was not statistically significant among the three groups (P > 0.05). The three protocols were generally well tolerated.
  
  
  CONCLUSIONS
  The sequential therapy has achieved a significantly higher eradication rate, and is a more suitable first-line alternative protocol for anti-H. pylori infection compared with the standard triple and bismuth pectin quadruple therapies.
authors.affiliation: Division of Gastroenterology, Weihai Municipal Hospital, Weihai 264200, Shandong Province, China. swc1975@hotmail.com
authors.forename: Xiao-Zhong
authors.initials: XZ
authors.lastname: Gao
authors.forename: Xiu-Li
authors.initials: XL
authors.lastname: Qiao
authors.forename: Wen-Chong
authors.initials: WC
authors.lastname: Song
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Wang
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D001729:Bismuth / Q000008:administration & dosage* / Q000009:adverse effects; D017291:Clarithromycin / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D010368:Pectins / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D000658:Amoxicillin; D010368:Pectins; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth
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