High efficacy of bismuth subcitrate for Helicobacter pylori eradication in pangastritis

Background: The influence of gastritis patterns in Helicobacter pylon eradication rates has been poorly investigated. Aims: To compare the efficacy of bismuth or proton pump inhibitors triple therapy for H. pylori eradication in pangastritis. Patients and methods: One hundred and eight patients with pangastritis were assigned to either lansoprazole 30 mg once a day (n = 54) or bismuth 240 mg bis in die (n = 54) for 14 days combined, for the first week, with amoxicillin 1 g plus metronidazole 250 mg tris in die. Eradication was confirmed by (13)C-urea breath test. Results: With bismuth, successful eradication was observed in 75.9% (41/54) in the intention-to-treat analysis and 78.8% (41/52) in the per-protocol analysis. With lansoprazole, the eradication rates were respectively 46.3% (25/54) and 51.0% (25/49). Bismuth had a significant higher efficacy according to both intention-to-treat analysis (p = 0.0029) and per-protocol analysis (p = 0.0038) with OR of 3.66 (95% CI: 1.61-8.32) and 3.58 (95% CI: 1.50-8.54) respectively. At regression analysis, the only independent variable affecting eradication was the type of regimen (p = 0.026) with an OR of 3.31 (95% CI: 1.16-9.44). Conclusions: In pangastritis patients, bismuth is more effective than PPI in first-line eradication. For improving the overall eradication rates, an evaluation of gastritis extent might need to be considered. (c) 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.