Tailored eradication vs empirical bismuth-containing quadruple therapy for first-line Helicobacter pylori eradication: A comparative,open trial

BACKGROUND Few studies have compared the efficacy and safety profile of a tailored eradication(TR) strategy based on the presence of a 23 S ribosomal RNA point mutation with those of empirical bismuth-based quadruple therapy(EBQT) for first-line eradication of Helicobacter pylori(H. pylori) in Korean patients.AIM To compare the efficacy and safety of a TR strategy and those of EBQT regimen as first-line eradication therapy for H. pylori.METHODS This is an open-label, comparative study in which we prospectively enrolled patients over 18 years of age with H. pylori infection and retrospectively reviewed their data. H. pylori-positive patients diagnosed by rapid urease test, Giemsa staining, or dual priming oligonucleotide polymerase chain reaction(DPO-PCR)were enrolled from May 2016 to September 2018 at Gil Medical Center. Patients with H. pylori infection received either a TR regimen or the EBQT regimen. In the tailored therapy group that underwent DPO-PCR testing, patients with A2142 G and/or A2143 G point mutations were treated with a bismuth-containing quadruple regimen. The eradication rate, patient-reported side effect rate, and H.pylori eradication success rate were evaluated and compared between the groups.RESULTS A total of 150 patients were assigned to the TR(n = 50) or EBQT group(n = 100).The first-line eradication rate of H. pylori did not differ between the groups(96.0% vs 95.7%, P = 0.9). The rate of eradication-related side effects for TR was12.0%, which differed significantly from that of EBQT(43.0%) for first-line treatment(P < 0.001).CONCLUSION DPO-PCR-based TR for H. pylori eradication may be equally efficacious, with less treatment-related complications, compared to EBQT in Korea, where clarithromycin resistance is high.