Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry onHelicobacter pyloriManagement (Hp-EuReg)
Authors: Pérez-Aisa Ángeles , Nyssen Olga P , Keco-Huerga Alma , Rodrigo Luís , Lucendo Alfredo J , Gomez-Rodriguez Blas J , Ortuño Juan , Perona Mónica , Huguet José María , Núñez Oscar , Fernandez-Salazar Luis , Barrio Jesus , Lanas Angel , Iyo Eduardo , Romero Pilar Mata , Fernández-Bermejo Miguel , Gomez Barbara , Garre Ana , Gomez-Camarero Judith , Lamuela Luis Javier , Campillo Ana , de la Peña-Negro Luisa , Dominguez Cajal Manuel , Bujanda Luis , Burgos-Santamaría Diego , Bermejo Fernando , González-Carrera Víctor , Pajares Ramón , Notari Pedro Almela , Tejedor-Tejada Javier , Planella Montserrat , Jiménez Itxaso , Lázaro Yolanda Arguedas , Cuadrado-Lavín Antonio , Pérez-Martínez Isabel , Amorena Edurne , Gonzalez-Santiago Jesús M , Angueira Teresa , Flores Virginia , Martínez-Domínguez Samuel J , Pabón-Carrasco Manuel , Velayos Benito , Algaba Alicia , Ramírez Consuelo , Almajano Enrique Alfaro , Castro-Fernandez Manuel , Alcaide Noelia , Sanz Segura Patricia , Cano-Català Anna , García-Morales Natalia , Moreira Leticia , Mégraud Francis , O'Morain Colm , Calvet Xavier , Gisbert Javier P 
Published: July 2023

Background

The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain.

Aim

To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry onHelicobacter pyloriManagement (Hp-EuReg).

Methods

All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection.

Results

Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection.

Conclusions

ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.