In a prospective single-center cohort from Portugal from 2013–2024 concomitant quadruple therapy (QuadC) and bismuth quadruple therapy (QuadB) achieved H. pylori eradication rates of 93% and 90%, respectively, on intention-to-treat analysis, significantly outperforming standard triple therapy at 74%.

Sequential quadruple therapy (QuadS) achieved 84%, with no significant difference versus QuadC or QuadB, reported Rita Regatia of the Portuguese Oncology Institute of Coimbra, and colleagues.

The 591 study participants had a median age of 57 years old and 57% were women. Most were evaluated for dyspeptic symptoms (61%). Treatment distribution was QuadC 34%, QuadB 33%, triple therapy 23%, and QuadS 10%, according to results presented at the United European Gastroenterology Week in Berlin.

Adverse events occurred more often with quadruple regimens—reported as 18% and 17% for QuadC and QuadB —compared with triple therapy (6%) or QuadS (2%). Despite the higher adverse event burden, overall adherence was 97% with no significant differences between regimens.

In multivariable analysis, prior eradication attempts, poor adherence, and absence of statin use independently predicted treatment failure. The authors noted internal inconsistencies in the confidence intervals, likely due to typesetting errors, though the directional associations were clear.

In a high prevalence setting where empirical therapy remains common, concomitant and bismuth quadruple regimens provided substantially higher eradication rates than triple therapy without an adherence penalty.

Sequential quadruple therapy, achieving 84% efficacy with fewer adverse events, may serve as a reasonable alternative when bismuth is unavailable. 

The authors report no conflicts of interest.

Source: UEG Week 2025