Comparison of Levofloxacin-Based, 10-day Sequential Therapy with 14-day Quadruple Therapy for Helicobacter Pylori Eradication: A Randomized Clinical Trial

BACKGROUND Considering the importance of Helicobacter pylori (H. pylori) eradication, this clinical trial was designed to prospectively evaluate the efficacy of levofloxacin-based, sequential therapy in comparison with quadruple therapy for eradicating H. pylori. METHODS Overall 156 patients with dyspepsia and H. pylori infection were included in this study and were randomly allocated to either 10-day sequential therapy group (group A) to receive pantoprazole (40 mg twice daily), amoxicillin (1 gr twice daily), levofloxacin (500 mg twice daily), and tinidazole (500 mg twice daily) (PALT) or 14-day quadruple therapy group (group B) to receive pantoprazole, clarithromycin, bismuth subcitrate, and amoxicillin (PABC). At the end of the study the eradication rate in each group was assessed by urea breath test (UBT). RESULTS Age range of the participants was 18-65 years (average 36.9 years) and 50% of them (78 patients) were men. 78 patients were allocated to group A and 78 patients to groupe B. After antibiotic therapy, all the patients received acid suppression therapy with Proton Pump Inhibitor (PPI) for 4 weeks and then the eradication rate was confirmed by UBT (Heli FAN plus 13C, Germany). Before performing UBT, all the participants were requested to halt consumption of PPI for at least 1 week. During the treatment there was not any major complication but in group A (sequential therapy), two patients complained of minor complications including musculoskeletal pain. None of the patients in group B had any complaint or side effect. The rate of H. pylori eradication in group A was 78.2% (61 patients) while this rate in group B was 83.3% (65 patients) with no significant difference between the two groups (p = 0.42). In subgroup analysis, the rate of eradication among men in group A and B were 76.9% and 89.7%, respectively (p = 0.22) while the eradication rate among women were 79.4% and 76.9%, respectively (p = 1.00). CONCLUSION It seems that levofloxacin base sequential therapy does not have any advantage in comparison with quadruple regimen and until finding any more effective short course therapy for H. Pylori eradication; we encourage quadruple regimen to be used as the first line therapy.

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A Randomized Controlled Trial Shows that both 14-Day Hybrid and Bismuth Quadruple Therapies Cure Most Patients with Helicobacter pylori Infection in Populations with Moderate Antibiotic Resistance

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00140-17 ◽

2017 ◽

Vol 61 (11) ◽

Cited By ~ 9

Author(s):

Feng-Woei Tsay ◽

Deng-Chyang Wu ◽

Hsien-Chung Yu ◽

Sung-Shuo Kao ◽

Kung-Hung Lin ◽

...

Keyword(s):

Helicobacter Pylori ◽

Antibiotic Resistance ◽

Eradication Rate ◽

Therapy Group ◽

Controlled Trial ◽

Hybrid Therapy ◽

Content Type ◽

Quadruple Therapy ◽

H Pylori ◽

To Receive

ABSTRACT Hybrid therapy is a novel two-step treatment achieving a high eradication rate for Helicobacter pylori infection. Currently, whether this new therapy achieves a higher eradication rate than bismuth quadruple therapy remains an unanswered question. The aim of this prospective, randomized comparative study was to investigate the efficacies of 14-day hybrid therapy and bismuth quadruple therapy in the treatment of H. pylori infection. From July 2013 to June 2015, eligible H. pylori-infected subjects were randomly assigned to receive either 14-day bismuth quadruple therapy (pantoprazole, bismuth subcitrate, tetracycline, and metronidazole for 14 days) or 14-day hybrid therapy (a 7-day dual therapy with pantoprazole plus amoxicillin, followed by a 7-day quadruple therapy with pantoprazole plus amoxicillin, clarithromycin, and metronidazole). H. pylori status was examined 6 weeks after the end of treatment. Three hundred thirty H. pylori-infected participants were randomized to receive 14-day bismuth quadruple therapy (n = 164) or 14-day hybrid therapy (n = 166). The eradication rates by intention-to-treat analysis were similar: 93.9% versus 92.8%, respectively (95% confidence interval [CI], −4.3% to 5.4%; P = 0.68). Per-protocol analysis yielded similar results (96.7% versus 94.9%, respectively; P = 0.44). However, bismuth quadruple therapy had a higher frequency of adverse events than hybrid therapy (55.5% versus 15.7%, respectively; 95% CI, 30.4% to 49.2%; P < 0.001). The two treatments exhibited comparable drug adherence (93.9% versus 97%, respectively). The resistance rates of antibiotics were: clarithromycin, 16.7% of patients; amoxicillin, 1.3%; metronidazole, 25%; and tetracycline, 0%. In the bismuth quadruple therapy group, the eradication rate of metronidazole-resistant strains was lower than that of metronidazole-susceptible strains (70.0% versus 96.4%, respectively; P = 0.04). In the hybrid therapy group, no significant impact of clarithromycin or metronidazole resistance on eradication rates was identified. Both 14-day hybrid and bismuth quadruple therapies cure most patients with H. pylori infection in populations with moderate antibiotic resistance. However, the 14-day hybrid therapy has fewer adverse effects than the bismuth quadruple therapy. (This study has been registered at ClinicalTrials.gov under identifier NCT02541864.)

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Modified Sequential Therapy Regimen versus Conventional Triple Therapy forHelicobacter pyloriEradication in Duodenal Ulcer Patients in China: A Multicenter Clinical Comparative Study

Gastroenterology Research and Practice ◽

10.1155/2012/405425 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Ying-Qun Zhou ◽

Ling Xu ◽

Bing-Fang Wang ◽

Xiao-Ming Fan ◽

Jian-Ye Wu ◽

...

Keyword(s):

Duodenal Ulcer ◽

Helicobacter Pylori ◽

Triple Therapy ◽

Eradication Rate ◽

Sequential Therapy ◽

Burning Pain ◽

Standard Triple Therapy ◽

Group A ◽

H Pylori ◽

Group B

Objective. Antimicrobial resistance has decreased eradication rates forHelicobacter pyloriinfection worldwide. To observe the effect of eradicatingHelicobacter pylori (H. pylori)and the treatment of duodenal ulcer by 2 kinds of modified sequential therapy through comparing with that of 10-day standard triple therapy.Methods. A total of 210 patients who were confirmed in duodenal ulcer active or heal period by gastroscopy andH. pyloripositive confirmed by rapid urease test, serum anti-H. pyloriantibody (ELASE), or histological examination enrolled in the study. All the patients were randomly divided into three groups: group A (70 cases) and group B (70 cases) were provided 10-day modified sequential therapy; group C (70 cases) was provided 10-day standard triple therapy. Patients of group A received 20 mg of Esomeprazole, 500 mg of Clarithromycin for the first 5 days, followed by 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for the remaining 5 days. Group B received 20 mg of Esomeprazole, 1000 mg of Amoxicillin for the first 5 days, followed by 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for the remaining 5 days. Group C received 20 mg of Esomeprazole, 500 mg of Clarithromycin, and 1000 mg of Amoxicillin for standard 10-day therapy. All drugs were given twice daily.H. pylorieradication rate was checked four to eight weeks after taking the medicine by using a13C urea breath test. In the first, second, third, seventh, twenty-first, thirty-fifth days respectively, the symptoms of patients such as epigastric gnawing, burning pain, and acidity were evaluated simultaneously.Results. Overall, 210 patients accomplished all therapy schemes, 9 case patients were excluded. The examination result indicated that theH. pylorieradication rate of each group was as follows: group A 92.5% (62/67), group B 86.8% (59/68), and group C 78.8% (52/66). TheH. pylorieradication rate of group A was slightly higher than group B (P<0.05) and both of them were obviously higher than group C (P<0.05). Modified sequential therapy was significantly more effective in patients with clarithromycin-resistant strains (80%/67% versus 31%;P=0.02). Symptoms improvement: all the three groups could improve the symptoms such as epigastric gnawing, burning pain, and acidity since the first day. There was no significant difference in total score descending of symptoms between each group (P>0.05).Conclusions. All the three therapy schemes could alleviate symptoms of duodenal ulcer patients in China efficiently. But as far as eradicatingH. pyloriis concerned, the modified sequential therapy was better than standard triple therapy, especially the therapy scheme used in group A.

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Moxifloxacin Based Triple Therapy as Alternative to Standard Therapy in Helicobacter Pylori Eradication.

Anti-Infective Agents ◽

10.2174/2211352518999200925154501 ◽

2020 ◽

Vol 18 ◽

Author(s):

Mohammed Hussien Ahmed ◽

Sherief Abd-Elsalam ◽

Aya Mohammed Mahrous

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Therapy Group ◽

Low Cost ◽

High Rate ◽

Helicobacter Pylori Eradication ◽

Treatment Regimens ◽

Group A ◽

H Pylori ◽

Group B

Introduction: Helicobacter pylori eradication remains a problematic issue. We are in an urgent need for finding a treatment regimen that achieves eradication at a low cost and less side effect. Recent published results showing a high rate of resistance and with clarithromycin-based treatment regimens. The aim of the study was to compare moxifloxacin therapy and classic clarithromycin triple therapy in H. pylori eradication. Methods: This was a pilot study that enrolled 60 patients with helicobacter pylori associated gastritis. Diagnosis was done by assessment of H. pylori Ag in the stool. The patients were randomly assigned to receive either moxifloxacin based therapy (Group A), or clarithromycin based therapy (Group B) for two weeks. We stopped the treatment for another two weeks then reevaluation for cure was done. Results: 90 % of patients had negative H. pylori Ag in the stool after 2 weeks of stoppage of the treatment in group A versus 66.7 % in Group B. None of the patients in both groups had major side effects. Conclusion: Moxifloxacin-based therapy showed higher eradication power and less resistance when compared to clarithromycin triple therapy.

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The impact of probiotics supplementation on gut microbiota after Helicobacter pylori eradication: a multicenter, open-label, randomised trial

10.21203/rs.3.rs-18049/v1 ◽

2020 ◽

Author(s):

Bo Tang ◽

Li Tang ◽

Cheng Huang ◽

Chuan Tian ◽

Ling Chen ◽

...

Keyword(s):

Helicobacter Pylori ◽

Gut Microbiota ◽

Randomised Trial ◽

Eradication Therapy ◽

Open Label ◽

Quadruple Therapy ◽

Alpha And Beta Diversity ◽

Group A ◽

H Pylori ◽

Group B

Abstract Background: Helicobacter pylori (H. pylori) eradication therapy may lead to the perturbation of gut microbiota. The role of probiotics in gut microbiota during eradication therapy is still debated. Design: This was a multicentre, open-label, randomised trial done at seven hospitals in China. 162 patients were enrolled, 79 patients were randomly divided into group A (bismuth quadruple therapy), and 83 patients were randomly subjected into group B (bismuth quadruple therapy supplemented with Medilac-S). Faecal samples were collected before treatment and 2 weeks, 4 weeks, 6 weeks, and 8 weeks after eradication therapy. Gut microbiota was analyzed by 16S rRNA high-throughput sequencing. This trial is complete and registered with Chinese Clinical Trial Registry (Chictr.org.cn, ChiCTR1900022116). Results: The eradication rates of group A and group B were 82.43% and 87.01%, respectively (P>0.05). Compared with baseline, alpha and beta diversity was significantly altered 2 weeks after eradication in both group A and group B, which was restored at week 8. There were no significant differences in alpha and beta diversity between the two groups. Bismuth quadruple therapy resulted in enrichment of some detrimental bacteria taxa such as Klebsiella and Streptococcus that were not recovered by week 8. Probiotics supplementation could rapidly restore the taxa levels of Klebsiella and Streptococcus by week 4 after eradication, and increase the beneficial taxa of Bacillus and Lactobacillales. Functional analysis revealed that lipopolysaccharide biosynthesis and polymyxin resistance pathways were significantly enriched after eradication therapy, while probiotics supplementation mainly enriched the cofactors and vitamins metabolism pathways. Several detrimental taxa were identified to be correlated with features of older age, alcohol use and high BMI, while probiotics supplementation could effectively restore the adverse impact in patients with these characteristics.Conclusion: Probiotics supplementation is beneficial for patients during H. pylori eradication, especially for patients with older age, alcohol drinking, and obesity, which might obtain the maximum benefits.

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Efficacy of compoundLactobacillus acidophilustablets combined with quadruple therapy forHelicobacter pylorieradication and its correlation with pH value in the stomach: a study protocol of a randomised, assessor-blinded, single-centre study

BMJ Open ◽

10.1136/bmjopen-2018-023131 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023131 ◽

Cited By ~ 1

Author(s):

Wen Ji ◽

Wei-Qing Chen ◽

Xu Tian

Keyword(s):

Study Protocol ◽

Eradication Rate ◽

Therapy Group ◽

Eradication Therapy ◽

Gastric Ph ◽

Quadruple Therapy ◽

Cancer Hospital ◽

Group A ◽

Group B ◽

Randomised Controlled

IntroductionHelicobacter pylori(Hp) is an important pathogenic factor for chronic gastritis, peptic ulcer, gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma and other diseases. In China, the Hp infection rate is high, but the eradication rate is decreasing. A large number of literatures have shown that the addition ofLactobacillus acidophiluscan improve the Hp eradication rate and reduce the side effects of antibiotic treatments. At present, the exact mechanism and curative effect ofL. acidophilusin the eradication of Hp have not yet been determined, and the conclusions obtained from relevant meta-analyses at home and abroad are different. Thus, it is very necessary and urgent to further complete a high-quality, clinical, randomised controlled trial research. If this study is successful, it can provide a new idea and a plan for Hp eradication therapy.Methods and analysisThis study is a prospective, randomised controlled, single-blinded, parallel-design trial. We will randomly assign 526 adult patients (≥18 years but <70 years) with Hp confirmed positive by the kit for 14C-urea breath test. Eligible subjects were randomly divided into two groups (group A and group B), with 263 subjects in each group. Group A is a quadruple therapy group, while group B is anL. acidophilustablets combined with quadruple therapy group. All patients were examined by gastroscopy, and 50 patients in each group will be placed under gastric pH monitor. The Hp eradication rate is the primary outcome. The secondary outcomes include gastric pH situation and adverse drug reactions.Ethics and disseminationThe study protocol has been approved by the Clinical Research Ethics Committees of Chongqing University Cancer Hospital and Chongqing Cancer Hospital (2018[012]). The results from this trial will be submitted for publication in peer-reviewed journals and will be presented at national and international conferences.Trial registration numberChiCTR17014185; Pre-results.

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CLINICAL EVALUATION OF TRIPLE AND QUADRUPLE HELICOBACTER PYLORI ERADICATION THERAPY IN PEPTIC ULCER PATIENTS WITH DIFFERENT ABO BLOOD GROUP PHENOTYPES

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i7.24692 ◽

2018 ◽

Vol 11 (7) ◽

pp. 460

Author(s):

Manal Khalid Abdulridha ◽

Rana Hussein Kutaif ◽

Yassir Mustafa Kamal ◽

Akram Ajeel Najeeb

Keyword(s):

Peptic Ulcer ◽

Triple Therapy ◽

Blood Group ◽

Eradication Rate ◽

Abo Blood Group ◽

Quadruple Therapy ◽

Blood Group A ◽

Group A ◽

H Pylori ◽

Group B

Objective: This study aimed to examine the pathological changes in gastric mucosa of Helicobacter pylori-infected peptic ulcer patients carrying different ABO phenotypes and to study the response to the 14 days’ standard triple therapy and 10 days’ quadruple therapy in peptic ulcer patients according to their ABO phenotypes.Methods: Interventional prospective randomized-controlled open-label study was performed on newly diagnosed patients with PUD. The H. pylori-positive patients were allocated into two major study groups in which they are subdivided according to ABO blood group phenotypes: Group 1 received standard H. pylori eradication triple therapy and Group 2 received standard H. pylori eradication quadruple regimen. Patients were monitored after 2 months for successful H. pylori eradication.Results: Chronic active gastritis was significantly high in patients carrying blood Group O phenotype (81.25%), while the atrophic gastritis and intestinal metaplasia were significantly high in patients carrying blood Group A phenotype (25.00% and 16.67%), respectively. 14 days’ triple therapy showed significantly lower eradication rate in H. pylori-infected peptic ulcer patients carrying blood Group O phenotype (p<0.01), meanwhile higher response was found among patients with blood Group B. 10 days’ quadruple therapy produced a significant high eradication rate in H. pylori-infected patients carrying blood Group O than those with blood Group A (p<0.01), but still both showed lower response compared to that in patients carrying blood Group B and AB phenotypes. Elderly patients showed significantly less healing efficacy than younger patients (p<0.01), and the least healing rate was noticed in female patients after both regimens.Conclusion: Lower eradication rate in H. pylori-infected was noticed in peptic ulcer patients carrying blood Group O mainly than those with other blood groups and particularly those with duodenal Ulceri. 10 days’ quadruple therapy showed significant higher eradication rate in H. pylori infection and a better ulcer healing efficacy.

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Efficacy of dexlansoprazole-based triple therapy for Helicobacter pylori infections

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819870960 ◽

2019 ◽

Vol 12 ◽

pp. 175628481987096

Author(s):

Chia-Jung Kuo ◽

Chun-Wei Chen ◽

Puo-Hsien Le ◽

Jun-Te Hsu ◽

Cheng-Yu Lin ◽

...

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Breath Test ◽

Eradication Rate ◽

Urea Breath Test ◽

Helicobacter Pylori Eradication ◽

Treatment Regimens ◽

Group A ◽

H Pylori ◽

Group B

Background: Dexlansoprazole has been shown to be efficacious for the treatment of gastroesophageal reflux disease. However, there is a paucity of data about its efficacy for Helicobacter pylori eradication. The aim of this study was to evaluate the efficacy of dexlansoprazole for H. pylori eradication as triple therapy in real-world practice. Methods: Adult patients with endoscopically proven H. pylori related peptic ulcer diseases or gastritis were recruited for this study. The eradication status was assessed based on the results of the 13C-urea breath test performed 4 weeks after treatment. According to the different treatment regimens, the patients were allocated to group A: Esomeprazole 40 mg b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days; group B: Esomeprazole 40 mg q.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days, or group C: Dexlansoprazole 60 mg q.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days. Results: A total of 215 patients (49% males) were enrolled in this study, with a mean age of 55 years. The eradication rates in group A, B, and C were 94.7% (71/75), 89.6% (69/77), and 93.7% (59/63) ( p = 0.457), respectively. The adverse events were similar between the three groups ( p = 0.068). Conclusions: This study suggests that dexlansoprazole-based triple therapy has an acceptable eradication rate for H. pylori infection.

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The impact of bismuth adding to rabeprazole, amoxicillin and clarithromycin on eradication rate of Helicobacter pylori

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20203149 ◽

2020 ◽

Vol 9 (8) ◽

pp. 1280

Author(s):

Mohammad Sadrkabir ◽

Masoud Tasouji ◽

Afshan Sharghi ◽

Abbas Yazdanbod

Keyword(s):

Helicobacter Pylori ◽

Eradication Rate ◽

High Prevalence ◽

Group A ◽

Stool Antigen ◽

The Difference ◽

H Pylori ◽

Group B ◽

The Impact ◽

Optimal Regimen

Background: High prevalence of Helicobacter pylori infection and induction of resistance as a result of consumption of antibiotics necessitates an ongoing effort for evaluation of new regimen to overcome this phenomenon. Intensive efforts are being made to identify such an optimal regimen, but there are many obstacles hindering the achievement of this goal. This study aimed to investigate the impact of adding bismuth to rabeprazole, amoxicillin and clarithromycin on rate of H. pylori eradication.Methods: In this randomized clinical trial, 60 patients with dyspepsia and positive gastric biopsy for H. pylori in endoscopy were recruited. The first group (A) received rabiprazole for 6 weeks, amoxicillin and clarithromycin for 2 weeks either with bismuth for 2 weeks and the second group (B) received rabiprazole for 6 weeks, amoxicillin and clarithromycin for 2 weeks either without bismuth. Four weeks after the treatment, the compliance and eradication were evaluated using stool antigen of helicobacter. The patients who could complete the therapeutic regimen were assigned for analysis.Results: H. pylori eradication rates were 70% and 56.6% in two groups A and B (with and without Bismuth), respectively and the difference was significant. There is a significant relationship between the studied groups and the results of fecal antigen of H. pylori.Conclusions: The bismuth had a significant effect on the success of eradication rate of H. pylori and its impact adding to the treatment regimen containing clarithromycin was effective on eradication success rate.

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COMPARISON OF EFFECTIVENESS OF STANDARD TRIPLE THERAPY VERSUS BISMUTH-BASED THERAPY FOR THE MANAGEMENT OF PEPTIC ULCER DISEASE DUE TO HELICOBACTER PYLORI

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i8.37884 ◽

2020 ◽

pp. 192-195

Author(s):

MIRZA MISBA ALI BAIG ◽

UZMA PARVEEN ◽

RUQAIAH FAROOQ ◽

MAIMUNA TABASSUM ◽

FATIMA NAAZ ◽

...

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Triple Therapy ◽

Eradication Rate ◽

Therapy Group ◽

Quadruple Therapy ◽

Ulcer Disease ◽

Standard Triple Therapy ◽

H Pylori

Objective: Helicobacter pylori is the primary agent causing peptic ulcer, therefore imposing a significant impact on health elated quality of life, consequently affecting nearly 50% of global population. The objective of this study is to determine and assess the effectiveness of triple therapy versus bismuth containing quadruple therapy for eradication of peptic ulcer disease due to H. pylori. Methods: A prospective randomized observational study was conducted at Princess Esra Hospital, Department of Gastroenterology for a period of 6 months. A total of 100 patients were randomly allocated in tow groups. The data were assessed using various parameters. H. pylori eradication was validated using rapid urease test done at the start treatment 4 weeks after the completion. Results: A total of 100 patients were recruited in the study. In triple therapy group medication adherence rate was found to be 82% in triple and 92% in quadruple therapy. The eradication rate was assessed using Chi-square test it was 82% and 97% in triple and quadruple therapy group, respectively. Hence, the difference was found to be statistically significant value <0.005. In addition, increased recurrence rate has been observed in triple therapy (17%) in contrast with quadruple therapy (2%). Conclusion: Addition of bismuth to significant triple therapy improves cure rates with minimal side effects. Interestingly, we observed that when bismuth was added, it produced a significant higher eradication rate (97%) when compared with standard triple therapy (82%). According to our study, bismuth is highly effective treatment of peptic ulcer disease.

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Analysis of the Effect of Different Treatment Schemes on Helicobacter Pylori Infection on Improving the Quality of Life of Patients

Proceedings of Anticancer Research ◽

10.26689/par.v5i1.1879 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Zhi Zong

Keyword(s):

Quality Of Life ◽

Helicobacter Pylori ◽

Eradication Rate ◽

Combined Treatment ◽

Sequential Therapy ◽

Helicobacter Pylori Infection ◽

Group A ◽

Group B ◽

Colloidal Bismuth

Objective: To analyze the effect of different treatment schemes on the quality of life of patients with Helicobacter pylori infection. Methods: From June 2019 to November 2020, 96 patients with Helicobacter pylori infection were selected and randomly assigned Combined treatment with omeprazole, amoxicillin and clarithromycin was named group A; Group B was treated with omeprazole, amoxicillin, clarithromycin and colloidal bismuth pectin; Group C was given omeprazole, amoxicillin, clarithromycin and metronidazole. Results: The symptom score and gastroscope score of group B or C were lower than those of group A (P < 0.05); The incidence of adverse reactions and HP eradication rate in group C were lower than those in group B, and those in group B were lower than those in group A (P < 0.05); The quality of life score of group C was higher than that of group B, and that of group B was higher than that of group A, P < 0.05. Conclusions: The sequential therapy of omeprazole, amoxicillin, clarithromycin and metronidazole in patients with Helicobacter pylori infection can improve the HP eradication rate, improve the quality of life of patients, which is safe and efficient.

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