Quadruple therapies are superior to standard triple therapy for Helicobacter pylori first-line eradication in Chile

Introduction: Helicobacter pylori infection affects approximately 70% of the Chilean popula-tion. It is a public health problem whose eradication treatment is part of the explicit health guarantees in Chile. Objectives: Characterize the most widely used H. pylori first-line eradication therapies in our environment and evaluate their efficacy. Methods: A retrospective observational study was carried out where, in patients with certified H. pylori infection, the eradication therapy indicated by the treating physician, its efficacy, adherence and adverse effects, in addition to the eradication certification method used, were evaluated. Results: 242 patients and 4 main therapies were analyzed: standard triple therapy, dual the-rapy, concomitant therapy, and bismuth quadruple therapy. Eradication rates of 81.9% (95% CI 74.44-87.63), 88.5% (95% CI 73.13-95.67), 93.7% (95% CI 78.07-98.44) and 97.6% (95% CI 84.81-99.67) were observed respectively, with concomitant therapy (RR: 1.14; 95% CI 1.01-1.29; p = .028) and quadruple therapy with bismuth (RR: 1.19; 95% CI 1.09-1.31; p < .001) being significantly more effective than standard triple therapy. Regarding the rate of reported adverse effects, it was 58.5% (95% CI 50.66-65.92), 35.4% (95% CI 24.6-48.11), 22.9% (95% CI 81-37.14) and 63.4% (95% CI 47.8-76.64), having the dual and concomitant therapy significantly fewer adverse effects compared with standard therapy. Conclusions: Quadruple therapies are superior to standard triple therapy and should be consi-dered as first-line treatment in Chile. Dual therapy is promising. More studies will be required to determine which therapies are most cost-effective. (C) 2021 Elsevier Espana, S.L.U. All rights reserved.

Automated summary

This retrospective observational study in Chile evaluated the efficacy of different Helicobacter pylori eradication therapies. The results showed that quadruple therapies and concomitant therapy were more effective than standard triple therapy, and dual therapy showed promise. Further studies are needed to determine the most cost-effective therapies.