# A Prospective Assessment of Helicobacter pylori Eradication Regimens in Treatment-Naïve Patients With Peptic Ulcer Disease

## TL;DR

This study compares different treatments for eradicating Helicobacter pylori in patients with peptic ulcers, finding that two newer regimens are more effective than the standard treatment.

## Contribution

The study provides a prospective comparison of first-line eradication regimens for H. pylori in treatment-naïve patients, identifying more effective therapies in the context of antibiotic resistance.

## Key findings

- Concomitant and bismuth-based quadruple therapies achieved higher eradication rates (89.41% and 85.54%) compared to standard triple therapy (72.62%).
- Antibiotic resistance, especially to metronidazole and clarithromycin, significantly reduced eradication success.
- Concomitant therapy and bismuth-based quadruple therapy were independently associated with improved eradication outcomes.

## Abstract

Background: Helicobacter pylori (H. pylori) infection is a leading cause of peptic ulcer disease (PUD), with eradication complicated by increasing antibiotic resistance.

Objective: To prospectively evaluate and compare the efficacy of various first-line H. pylori eradication regimens in treatment-naïve patients diagnosed with PUD.

Methodology: A prospective observational study was conducted from October 2023 to September 2024 at the Department of Gastroenterology, Azad Jammu and Kashmir Medical College and Abbas Institute of Medical Sciences, Muzaffarabad. A total of 252 endoscopically confirmed, treatment-naïve PUD patients were enrolled and assigned to one of the three regimens using a rotational system. Eradication success was evaluated at 6 weeks post-treatment via urea breath or stool antigen test. Antibiotic resistance was assessed using culture and sensitivity testing from gastric biopsies. Logistic regression was used to identify predictors of eradication success.

Results: Among 252 patients, 84 (33.33%) received standard triple therapy, 83 (32.94%) received bismuth-based quadruple therapy, and 85 (33.73%) received concomitant therapy. Overall, H. pylori eradication was achieved in 208 patients (82.54%), including 61 (72.62%) in the triple therapy group, 71 (85.54%) in the quadruple group, and 76 (89.41%) in the concomitant group (p=0.01). Resistance to metronidazole (n=131; 52.78%), clarithromycin (n=92; 36.51%), and amoxicillin (n=17; 6.75%) was associated with significantly reduced eradication rates, particularly in dual- and triple-resistant strains. Multivariate analysis confirmed that concomitant therapy (aOR: 2.72, p=0.007) and bismuth-based quadruple therapy (aOR: 2.11, p=0.033) were significantly more effective than standard triple therapy.

Conclusion: Concomitant and bismuth-based quadruple therapies are superior to standard triple therapy in H. pylori eradication, particularly in areas with high antibiotic resistance.