title: Second-line bismuth-containing quadruple therapy forHelicobacter pylorieradication and impact of diabetes.
abstract: OBJECTIVE
  To investigateHelicobacter pylori(H.pylori) eradication rates using second-line bismuth-containing quadruple therapy and to identify predictors of eradication failure.
  
  
  METHODS
  This study included 636 patients who failed first-line triple therapy and received 7 d of bismuth-containing quadruple therapy between January 2005 and December 2015. We retrospectively demonstratedH.pylorieradication rates with respect to the year of therapy as well as demographic and clinical factors.H.pylorieradication was confirmed by a13C-urea breath test or a rapid urease test at least 4 wk after the completion of bismuth-based quadruple therapy: proton pump inhibitor, metronidazole, bismuth, and tetracycline.
  
  
  RESULTS
  The overall eradication rates by intention-to-treat analysis and per-protocol analysis were 73.9% (95%CI: 70.1%-77.4%) and 94.5% (95%CI: 92.4%-96.5%), respectively. Annual eradication rates from 2005 to 2015 were 100.0%, 92.9%, 100.0%, 100.0%, 100.0%, 97.4%, 100.0%, 93.8%, 84.4%, 98.9%, and 92.5%, respectively, by per-protocol analysis. A multivariate analysis showed that diabetes mellitus (OR = 3.99, 95%CI: 1.56-10.20,P= 0.004) was associated withH.pylorieradication therapy failure.
  
  
  CONCLUSIONS
  The second-line bismuth-containing quadruple therapy forH.pyloriinfection is still effective in Korea, and diabetes mellitus is suggested to be a risk factor for eradication failure.
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Moo In
authors.initials: MI
authors.lastname: Park
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Seun Ja
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Moon
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Kyoungwon
authors.initials: K
authors.lastname: Jung
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Hae Koo
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea.
authors.forename: Young Dal
authors.initials: YD
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000863:Antacids / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use*; D001944:Breath Tests; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D060740:Disease Eradication / Q000379:methods*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013752:Tetracycline / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000863:Antacids; D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D013752:Tetracycline; D001729:Bismuth
keywords: Bismuth; Diabetes mellitus; Disease eradication; Helicobacter pylori; Treatment failure