Falling eradication rates of Helicobacter pylori (H. Pylori) have prompted changes in the first-line bismuth-containing quadruple therapy. This study aimed to assess the effectiveness of different proton-pump inhibitor (PPI) based quadruple regimens for H. pylori eradication.

Electronic records were examined to acquire information on H. pylori-positive patients treated with a 14-day bismuth-containing quadruple regimen (PPIs, amoxicillin, clarithromycin, and bismuth). Patient demographics and eradication regimen data were also analyzed. Four groups were formed based on the different PPIs: ilaprazole, esomeprazole, omeprazole, and rabeprazole groups. Eradication rates were calculated, and the effectiveness of the treatment regimens was compared.

A total of 2637 patients were included, comprising 1469 males and 1168 females. Of these, 22.4 % (n = 590) were treated with an ilaprazole-based quadruple regimen, 33.8 % (n = 892) with an esomeprazole-based regimen, 16.6 % (n = 439) with an omeprazole-based regimen, and 27.2 % (n = 716) with a rabeprazole-based regimen. Eradication rates were significantly higher in the esomeprazole-based regimen than in the ilaprazole-, omeprazole-, and rabeprazole-based regimens (75.2 % vs. 65.8 % vs. 65.4 % vs. 70.9 %, P = 0.001).

The eradication rates across various PPI-based quadruple regimens were comparable; however, the regimen comprising amoxicillin and clarithromycin demonstrated low efficacy and is not advised in settings with high clarithromycin resistance. Among the effective therapeutic regimens, the esomeprazole-based regimen exhibited a slightly higher eradication rate.

Helicobacter pylori

Proton pump inhibitors

Bismuth

Quadruple therapy

Eradication rate

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