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Introduction <p>Helicobacter pylori (H. pylori) eradication is a continuously challenging issue as antibiotic resistance is evolving and adversely affecting outcomes of previously effective treatments. Continual assessment and modification of therapeutic approaches is necessary.</p> Aim <p>The aim of our study was to evaluate H. pylori eradication rate in Tunisian patients treated by non-bismuth quadruple therapy and to investigate treatment failure factors.</p> Methods <p>We conducted a prospective multicentric study including patients with H. pylori infection. For all patients, concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus esomeprazole 40 mg) twice daily for 14 days was prescribed. Mutations conferring resistance of H. pylori to clarithromycin were detected using polymerase chain reaction on gastric biopsies. Eradication was assessed using the urea breath test.</p> Results <p>414 patients were included. The mean age was 44.7 ± 14.3 with a sex ratio of M/F = 0.53. Mutations conferring resistance of H. pylori to clarithromycin were observed in 76 patients (18.35%). During follow-up, adverse effects to treatment occurred in 34.5% of patients. Eradication rate was 88.2% (95% CI: [85.1–91.3]) in per protocol analysis. In multivariate analysis, female gender (OR:2.924, 95% CI (1.340–6.380), <i>p</i> = 0.009) and the presence of clarithromycin resistance gene (OR:4.671, 95% CI (2.444–8.925), <i>p</i> &lt; 0.001) were predictors of treatment failure.</p> Conclusion <p>Concomitant therapy showed an eradication rate below 90% in Tunisian patients, mainly due to clarithromycin resistance and female gender. However, non-bismuth quadruple therapy remains a viable alternative option, achieving eradication in more than 8 out of 10 patients.</p> Clinical trial <p>Not applicable</p>

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Helicobacter pylori eradication rate following first line non-bismuth quadruple therapy regimen in Tunisian patients: the HPERAD study

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  • 发表日期：

    2025年12月25日

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  • Monia Fekih,
  • Taieb Jomni,
  • Myriam Ayari,
  • Hajer Battikh,
  • Meriem Zribi,
  • Asma Labidi,
  • Meriem Serghini,
  • Nadia Ben Zid,
  • Marwa Hafi,
  • Jalel Boubaker,
  • Alaa Nciri,
  • Mehdi Ben Abdelwahed,
  • Mejda Zakhama,
  • Mohamed Hichem Loghmari,
  • Raoua Baklouti,
  • Arwa Guediche,
  • Wided Bouhlel,
  • Imen Jemni,
  • Asma Sabbek,
  • Nabil Ben Chaabene,
  • Leila Safer,
  • Ons Haddad,
  • Yosr Kadri,
  • Hajer Rhim,
  • Maha Mastouri,
  • Emna Belhadj Mabrouk,
  • Asma Mensi,
  • Shema Ayadi,
  • Yosra Zaimi,
  • Yosra Said,
  • Leila Mouelhi,
  • Radhouane Debbeche,
  • Mehdi Kchaou,
  • Wafa Haddad,
  • Lassaad Chtourou,
  • Hamadi Chabchoub,
  • Mohamed Turki,
  • Mourad Njeh,
  • Amine Mzid,
  • Nesrine Medjahed,
  • Basma Mnif,
  • Adnene Hammami,
  • Hatem Ben Abdallah,
  • Ghanem Mohamed,
  • Nabil Abdelli,
  • Imen Abdelaali,
  • Mohamed Hedi Douggui,
  • Mouna Medhioub,
  • Amal Khsiba,
  • Moufida Mahmoudi,
  • Asma Ben Mohamed,
  • Manel Yakoubi,
  • Lamine Hamzaoui,
  • Mohamed Moussadek Azzouz,
  • Norsaf Bibani,
  • Dorra Trad,
  • Meriam Sabbah,
  • Houssaina Jlassi,
  • Hela Elloumi,
  • Dalila Gargouri,
  • Bochra Bouchabou,
  • Abdelwaheb Nakhli,
  • Nesrine Hemdani,
  • Rym Ennaifer,
  • Leila Bel Hadj Ammar,
  • Soumaya Nsibi,
  • Raja Tlili,
  • Lamia Kallel,
  • Sonia Ben Hamida,
  • Hanen Elloumi,
  • Imed Cheikh,
  • Mariem Nouira,
  • Samir Ennigrou

摘要

Introduction

Helicobacter pylori (H. pylori) eradication is a continuously challenging issue as antibiotic resistance is evolving and adversely affecting outcomes of previously effective treatments. Continual assessment and modification of therapeutic approaches is necessary.

Aim

The aim of our study was to evaluate H. pylori eradication rate in Tunisian patients treated by non-bismuth quadruple therapy and to investigate treatment failure factors.

Methods

We conducted a prospective multicentric study including patients with H. pylori infection. For all patients, concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus esomeprazole 40 mg) twice daily for 14 days was prescribed. Mutations conferring resistance of H. pylori to clarithromycin were detected using polymerase chain reaction on gastric biopsies. Eradication was assessed using the urea breath test.

Results

414 patients were included. The mean age was 44.7 ± 14.3 with a sex ratio of M/F = 0.53. Mutations conferring resistance of H. pylori to clarithromycin were observed in 76 patients (18.35%). During follow-up, adverse effects to treatment occurred in 34.5% of patients. Eradication rate was 88.2% (95% CI: [85.1–91.3]) in per protocol analysis. In multivariate analysis, female gender (OR:2.924, 95% CI (1.340–6.380), p = 0.009) and the presence of clarithromycin resistance gene (OR:4.671, 95% CI (2.444–8.925), p < 0.001) were predictors of treatment failure.

Conclusion

Concomitant therapy showed an eradication rate below 90% in Tunisian patients, mainly due to clarithromycin resistance and female gender. However, non-bismuth quadruple therapy remains a viable alternative option, achieving eradication in more than 8 out of 10 patients.

Clinical trial

Not applicable