A comparative study of eradication rates, adverse events, and compliance between triple therapy and bismuth-containing quadruple therapy in children with Helicobacter pylori infection

Purpose To compare the eradication efficacy, symptom improvement, and safety between standard triple therapy and bismuth-containing quadruple therapy for Helicobacter pylori ( H. pylori ) infection in children. Methods This retrospective cohort study included 161 pediatric patients who completed either a 14-day triple therapy (proton pump inhibitor, clarithromycin, amoxicillin; n = 78) or a 14-day bismuth-containing quadruple therapy (adding colloidal bismuth subcitrate; n = 83). The primary outcome was the eradication rate assessed by 13 C-urea breath test 4 weeks post-treatment. Secondary outcomes included changes in abdominal pain, bloating, and nausea scores (measured by a 4-point Likert scale before and after treatment) and the incidence of adverse events. Results The eradication rate was significantly higher in the bismuth-containing quadruple therapy group (90.36%) compared to the triple therapy group (74.36%) ( P = 0.007). Post-treatment symptom scores improved more markedly with bismuth-containing quadruple therapy for abdominal pain (0.68 vs. 0.85, P < 0.001), bloating (0.55 vs. 0.64, P = 0.021), and nausea (0.35 vs. 0.41, P = 0.024). In a subgroup analysis restricted to patients with successful eradication, the bismuth-containing quadruple therapy group still had significantly lower abdominal pain scores ( P = 0.002), suggesting a potential independent effect of bismuth on abdominal pain relief. The incidence of adverse events and the medication compliance rate were comparable between the two groups ( P > 0.05). Multivariate analysis identified bismuth-containing quadruple therapy as a protective factor against eradication failure (Adjusted OR = 0.351, P = 0.018). Conclusion Bismuth-containing quadruple therapy is potentially advantageous to standard triple therapy for eradicating H. pylori and alleviating associated symptoms in children, with a similar safety and compliance profile.