To evaluate the efficacy, safety and influencing factors of two bismuth-containing quadruple therapies in the treatment of recurrent Helicobacter pylori (H. pylor) infection.

Total of 95 patients with H. pylor recurrence infection from March 2017 to October 2020 in Tsinghua University Yuquan Hospital (Tsinghua University Hospital of Integrated Traditional Chinese and Western Medicine) were divided into experimental group (45 cases) and control group (50 cases) by ramdom envelope method, and there were 31 cases and 28 cases with atrophic gastritis in experimental group and control group, respectively. The experimental group were treated with colloidal bismuth pectin (200 mg, twice a day) + rabeprazole (10 mg, twice a day) + amoxicillin (1 000 mg, twice a day) + moxifloxacin (0.4 mg, once a day). The control group were treated with bismuth pectin (200 mg, twice a day) + rabeprazole (10 mg, twice a day) + amoxicillin (1 000 mg, twice a day) + metronidazole (0.4 mg, three times a day). All patients of the two groups were treated for 2 weeks. Then ¹³C urease breath test were performed on cases in both groups after 4-8 weeks. The eradication rate of recurrent H. pylor, eradication rate of cases with atrophic gastritis and the incidence of adverse drug reactions in 4 weeks after treatment were evaluated by Chi-square test. The risk factors for recurrent treatment failure of H. pylor were analyzed by Univariate and multivariate Logistic regression analysis.

In experimental group, 45 cases completed the treatment after relapse, among them, 37 cases with H. pylor infection successfully eradicated, the eradication rates of intention-to-treat analysis (ITT) and per-protocol (PP) were 82.22% (37/45) and 94.87% (37/39), respectively. In control group, 50 cases completed the treatment after relapse, among them, 42 cases with H. pylor infection successfully eradicated, the eradication rates of ITT and PP were 82.22% (42/50) and 87.5% (42/48), respectively. There were no significant differences between the two groups for the eradication rates of ITT (χ² = 0.783, P = 0.800) and PP (χ² = 1.551, P = 0.297). The incidences of adverse reactions of experimental group and control group were 8.0% (4/45) and 12% (6/50), respectively, with no significant difference (χ² = 0.243, P = 0.744). The eradication rates of ITT (96.77% vs. 75.85%) and PP (96.77% vs. 78.57%) after retreatment of patients complicated with atrophic gastritis in experimental group were significantly different from those of the control group (χ² = 5.670, P = 0.017; χ² = 4.662, P = 0.031). Univariate analysis showed that the eradication rates of ITT (91.57% vs. 25.00%) and PP (93.83% vs. 27.27%) between patients with different drug dependence (rate of taking medication ≥ 90% and < 90%) were significantly different (χ² = 28.59, P < 0.001; χ² = 8.138, P = 0.004). However, there was no significant difference for the eradication rates of ITT and PP between patients with different factors, such as age, sex, smoking, alcohol consumption, dyspepsia, dyspepsia, diabetes, hypertension, DOB value and radical drugs (all P > 0.05). Multivariate Logistic analysis showed that drug dependence was a factor influencing the recurrent curative efficacy after the eradication of H. pylori infection (OR = 0.035, 95%CI: 0.007-0.199, P < 0.001).

Both moxifloxacin based bismuth-containing quadruple therapy and metronidazole based bismuth-containing quadruple therapy could be used to treat patients with recurrent H. pylor infection; with similar incidence of adverse reactions. Drug compliance was an independent influencing factor for the efficacy of radical treatment for recurrence of H. pylor infection.