Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2017; 23(6): 1059-1066
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1059
Second-line bismuth-containing quadruple therapy for Helicobacter pylori eradication and impact of diabetes
Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Hae Koo Kim, Young Dal Lee
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
Author contributions: Kim SE interpreted and analyzed the data and wrote the manuscript; Park MI designed, organized, and supervised writing of the manuscript; Park SJ and Moon W helped with data interpretation that was used in the current study; Kim JH and Jung K provided input and organized the data for statistical analysis; Kim HK and Lee YD helped with data analysis; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Kosin University Gospel Hospital Institutional Review Board (IRB file No. 2015-03-018).
Conflict-of-interest statement: We have no conflicts of interest regarding the current paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moo In Park, MD, Professor, Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, South Korea. mipark@kosinmed.or.kr
Telephone: +82-51-9906719 Fax: +82-51-9905055
Received: October 17, 2016
Peer-review started: October 18, 2016
First decision: October 28, 2016
Revised: November 21, 2016
Accepted: January 18, 2017
Article in press: January 18, 2017
Published online: February 14, 2017
Processing time: 118 Days and 0.7 Hours
Abstract

AIM

To investigate Helicobacter 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 demonstrated H. pylori eradication rates with respect to the year of therapy as well as demographic and clinical factors. H. pylori eradication was confirmed by a 13C-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 with H. pylori eradication therapy failure.

CONCLUSION

The second-line bismuth-containing quadruple therapy for H. pylori infection is still effective in Korea, and diabetes mellitus is suggested to be a risk factor for eradication failure.

Keywords: Helicobacter pylori; Disease eradication; Treatment failure; Bismuth; Diabetes mellitus

Core tip: This study investigated the efficacy of 7 d of second-line bismuth-containing quadruple therapy for Helicobacter pylori (H. pylori) infection and identified risk factors for eradication failure in South Korea. The overall eradication rate per-protocol analysis was 94.5% in the current study. Additionally, diabetes mellitus was related to H. pylori eradication therapy failure. Therefore, second-line bismuth-containing quadruple therapy for H. pylori infection is still worth considering in South Korea, and diabetes mellitus is suggested to be a risk factor for eradication failure.