Efficacy and safety of ten-day bismuth quadruple therapy for first-line anti-Helicobacter pylori infection in the elderly- A multicenter real-world report

BACKGROUND: Aging may influence the effectiveness of Helicobacter pylori (H. pylori) eradication. The purpose of this study was to evaluate the efficacy and safety of 10-day bismuth quadruple therapy as a first-line treatment for H. pylori infection in elderly individuals. METHODS: We conducted a retrospective analysis of prospectively collected data from September 2018 to December 2021 in southern Taiwan. All patients received 10-day quadruple therapy consisting of rabeprazole 20 mg twice daily, bismuth subcitrate 120 mg four times daily, metronidazole 500 mg three times daily, and tetracycline 500 mg four times daily. Patients were categorized into two groups: an elderly group (aged ≥65) and a control group (aged <65). RESULTS: The study included 231 naive patients receiving 10-day quadruple therapy. The eradication rates in the elderly and control groups were 80.3 % (95 % confidence interval [CI]: 68.1 %-89.4 %) and 85.3 % (95 % CI: 79.1 %-90.3 %) (P = 0.364), respectively, in the intention-to-treat analysis. In the per-protocol analysis, eradication rates were 89.1 % (95 % CI: 77.8 %-95.9 %) for the elderly group and 94.8 % (95 % CI: 90.0 %-97.7 %) for the control group (P = 0.149). Adverse event rates were 34.5 % in the elderly group and 27.5 % in the control group (P = 0.322). Compliance was slightly lower in the elderly group than the control group (89.1 % vs. 95.4 %, P = 0.096). CONCLUSIONS: The efficacy of 10-day bismuth quadruple therapy as a first-line treatment for H. pylori was comparable between elderly and non-elderly cohorts, with similar levels of adverse effects.