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Role of bismuth in improving Helicobacter pylori eradication with triple therapy
  1. Maria Pina Dore1,4,
  2. Hong Lu2,3,
  3. David Y Graham4
  1. 1Dipartimento di Medicina Clinica e Sperimentale, Clinica Medica, University of Sassari, Sassari, Italy
  2. 2GI Division, Ren Ji Hospital, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University, Shanghai, China
  3. 3Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai, China
  4. 4Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  1. Correspondence to Dr David Y Graham, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, RM 3A-318B (111D), 2002 Holcombe Boulevard, Houston, TX 77030 USA; dgraham{at}bcm.edu

Abstract

In most regions of the world, antimicrobial resistance has increased to the point where empirical standard triple therapy for Helicobacter pylori eradication is no longer recommended. The treatment outcome in a population is calculated as the sum of the treatment success in the subpopulation with susceptible infections plus treatment success in the subpopulation with resistant infections. The addition of bismuth (ie, 14-day triple therapy plus bismuth) can improve cure rates despite a high prevalence of antimicrobial resistance. The major bismuth effect is to add an additional 30%–40% to the success with resistant infections. The overall result is therefore dependent on the prevalence of resistance and the treatment success in the subpopulation with resistant infections (eg, with proton-pump inhibitor–amoxicillin dual therapy). Here, we explore the contribution of each component and the mechanisms of how bismuth might enhance the effectiveness of triple therapy. We also discuss the limitations of this approach and provide suggestions how triple therapy plus bismuth might be further improved.

  • HELICOBACTER PYLORI
  • HELICOBACTER PYLORI - TREATMENT
  • PROTON PUMP INHIBITION
  • ANTIBIOTICS

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