Role of Bismuth

Recently, various results have been published on the change in success rate of Helicobacter pylori (H. pylori) eradication as the first-line standard triple therapy (STT), but many studies on the trend of eradication rate reduction due to antibiotic resistance have been reported. In addition, after the failure of first STT, the eradication rate for classic bismuth quadruple therapy (BQT) as a secondary eradication regimen has also dramatically decreased from more than 90% until 2008 to 70% of 2012. The reasons for this decrease in eradication rate include antibiotic resistance, age of patients, smoking status, differences in host immunity, underlying diseases, and reduced compliance, but among them, antibiotic resistance is known to be the most important factor. In particular, considering the high resistance rate of clarithromycin, it can be considered as more important factor in result of eradication rate. So far, it has been reported that 80~100% of the effects of clarithromycin resistance have resulted in eradication failure. A high level of resistance to clarithromycin cannot be resolved by increasing the amount of clarithromycin administration or extending the treatment period. Therefore, it is important to find new therapies without the problem of drug resistance.