Efficacy and safety of modified tetracycline dosing in a quadruple therapy for Helicobacter pylori:A retrospective single center study

BACKGROUND Although highly effective as a component of Helicobacter pylori(H.pylori)treatment regimen,tetracycline is associated with a high incidence of medicationrelated adverse events.Modified dosing of tetracycline as part of quadruple therapy may improve safety while providing comparable eradication rates.AIM To evaluate the efficacy and safety of modified dosing of tetracycline in patients receiving tetracycline and furazolidone-containing quadruple therapy in patients with H.pylori infection.METHODS Consecutive patients(10/2020-12/2021)who received tetracycline and furazolidone quadruple therapy for H.pylori infection at Sir Run Run Shaw Hospital were identified.All patients received tetracycline,furazolidone,proton pump inhibitor,and bismuth for 14 d as primary or rescue therapy.Modified tetracycline dose group received tetracycline 500 mg twice daily while standard group received 750 mg twice daily or 500 mg three times daily.RESULTS Three hundred and ninety-four patients[mean age=46.3±13.9,male=137(34.8%),and 309(78.4%)primary therapy]completed tetracycline and furazolidone quadruple therapy for H.pylori infection including those who received modified tetracycline dose in 157 and standard doses in 118(750 mg twice daily)and 119(500 mg three times daily).Eradication rates in the modified tetracycline dose group were 92.40%and in the standard groups,eradication rates were 93.20%for 750 mg twice daily group and 92.43%for 500 mg three times daily group,respectively,without statistical difference(P=0.959).The incidence of adverse events was lower in the modified tetracycline dose(15.3%vs 32.3%and 29.4%;P=0.002)compared to the standard dose group.CONCLUSION In a real-world experience,modified tetracycline dosing as part of tetracycline and furazolidone quadruple therapy for 14 d demonstrated high efficacy,comparable to standard tetracycline dose regimens,with a favorable safety profile.

Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial

BACKGROUND Increasing levels of antibiotic resistance have reduced the Helicobacter pylori(H.pylori)eradication rates afforded by the standard triple therapy.Thus,2-wk firstline four-drug regimens must be considered.AIM To analyze the eradication rates of modified bismuth-containing quadruple therapy(mBCQT)and concomitant therapy(CT),the associated adverse events,and compliance.METHODS Patients infected with H.pylori were prospectively randomized to receive mBCQT or CT for 2 wk.mBCQT featured a proton pump inhibitor(PPI),bismuth,metronidazole,and tetracycline,taken twice daily.CT included a PPI,clarithromycin,metronidazole,and amoxicillin,taken twice daily.The 13C-urea breath test was performed no earlier than 4 wk after therapy concluded to confirm eradication.If either the histological or rapid urease test was positive,H.pylori infection was diagnosed.RESULTS The demographic characteristics of 68 patients who received mBCQT and 68 who received CT did not differ significantly.On intention-to-treat analysis,the eradication rate was 88.2%(60/68)in the mBCQT group and 79.4%(54/68)in the CT group(P=0.162).By per-protocol analysis,the respective eradication rates were 98.4%(60/61)and 93.1%(54/58)(P=0.199).More CT than mBCQT patients experienced adverse events[33.8%(23/68)mBCQT vs 51.5%(35/58)CT patients,respectively,P=0.037].All patients showed good compliance[85.3%(58/68)mBCQT vs 82.4%(56/68)CT patients,P=0.641].CONCLUSION The H.pylori eradication rates of the 2-wk mBCQT and CT regimens are high.Most patients show good compliance,and more CT than mBCQT patients experience adverse events.

Exploration and Study of Jianpi Qushi Powder Combined with Standard Anti HP Quadruple Therapy in the Treatment of HP Infectious Gastritis of Spleen Deficiency and Dampness Stagnation Type

Objective: To explore the therapeutic effect of traditional Chinese medicine Jianpi Qushi powder combined with standard anti-HP quadruple therapy in the treatment of HP infectious gastritis with spleen deficiency and dampness stagnation. Methods: From January 2020 to December 2021, 223 patients with laboratory-confirmed HP infection who were admitted to the Outpatient and Inpatient Department of Internal Medicine in our hospital were selected as the research objects and randomly divided into two groups. 101 patients in the control group were given standard anti HP quadruple therapy;122 cases in the treatment group were given traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy. The two groups were rechecked carbon breath test after the designed course of treatment, and the curative effects of the two groups were compared. Results: 113 cases in the treatment group were cured by traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy, and the cure rate was 92.62%. 84 cases in the control group were cured by standard anti HP quadruple therapy, and the cure rate was 83.17%, χ2 = 4.7955, P = 0.0285, the difference was statistically significant (P < 0.05). Conclusion: Traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy in the treatment of HP infectious gastritis with spleen deficiency and dampness stagnation is one of the best treatment schemes for HP infection. The results of this study achieve the best clinical treatment effect, and provide a more valuable and reliable method for the treatment of gastropathy in clinical internal medicine, which is worthy of popularization and application.

Research Progress of Jianpi Qushi Powder Combined with Standard Anti Hp Quadruple Therapy in the Treatment of Hp Infectious Gastritis with Spleen Deficiency and Dampness Stagnation

Stomach Helicobacter pylori infection is one of the common gastric diseases. Helicobacter pylori infectious gastritis of spleen deficiency and dampness stagnation is a relatively intractable chronic disease. In recent years, traditional Chinese medicine methods have emerged one after another in the treatment of gastric Helicobacter pylori infection. By collecting references, the author reviewed the clinical characteristics of gastric Helicobacter pylori infection and the new progress of traditional Chinese medicine treatment.

Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

BACKGROUND A cure for Helicobacter pylori(H.pylori)remains a problem of global concern.The prevalence of antimicrobial resistance is widely rising and becoming a challenging issue worldwide.Optimizing sequential therapy seems to be one of the most attractive strategies in terms of efficacy,tolerability and cost.The most common sequential therapy consists of a dual therapy[proton-pump inhibitors(PPIs)and amoxicillin]for the first period(5 to 7 d),followed by a triple therapy for the second period(PPI,clarithromycin and metronidazole).PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics,hence the idea of using new generation molecules.This open-label prospective study randomized 328 patients with confirmed H.pylori infection into three groups(1:1:1):The first group received quadruple therapy consisting of twice-daily(bid)omeprazole 20 mg,amoxicillin 1 g,clarith-romycin 500 mg and metronidazole 500 mg for 10 d(QT-10),the second group received a 14 d quadruple therapy following the same regimen(QT-14),and the third group received an optimized sequential therapy consisting of bid rabe-prazole 20 mg plus amoxicillin 1 g for 7 d,followed by bid rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg for the next 7 d(OST-14).AEs were recorded throughout the study,and the H.pylori eradication rate was determined 4 to 6 wk after the end of treatment,using the 13C urea breath test.RESULTS In the intention-to-treat and per-protocol analysis,the eradication rate was higher in the OST-14 group compared to the QT-10 group:(93.5%,85.5%P=0.04)and(96.2%,89.5%P=0.03)respectively.However,there was no statist-ically significant difference in eradication rates between the OST-14 and QT-14 groups:(93.5%,91.8%P=0.34)and(96.2%,94.4%P=0.35),respectively.The overall incidence of AEs was significantly lower in the OST-14 group(P=0.01).Furthermore,OST-14 was the most cost-effective among the three groups.CONCLUSION The optimized 14-d sequential therapy is a safe and effective alternative.Its eradication rate is comparable to that of the 14-d concomitant therapy while causing fewer AEs and allowing a gain in terms of cost.

Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication in Chinese population:A prospective,multicenter,randomized,two-stage study

BACKGROUND The efficacy of Vonoprazan-amoxicillin dual therapy(VAT)in the treatment of Helicobacter pylori(H.pylori)is controversial.AIM To evaluate the efficacy of VAT in the Chinese population.METHODS This prospective,multicenter,randomized,open-label,and two-stage study was conducted at 23 centers in Fujian,China(May 2021-April 2022).H.pylori-infected patients were randomized to bismuth quadruple therapy(BQT),BQT-Vonoprazan(BQT-V),seven-day VAT(VAT-7),ten-day VAT(VAT-10),and fourteen-day VAT(VAT-14)groups.The primary endpoint was the H.pylori eradication rate.The secondary endpoint was the frequency of adverse events.This study was registered with the Chinese Clinical Trial Registry,ChiCTR2100045778.RESULTS In the first stage,VAT-7 and BQT-V groups were selected for early termination because less than 23 among 28 cases were eradicated.In the second stage,the eradication rates for BQT,VAT-10,and VA-14 were 80.2%[95%confidence interval(95%CI):71.4%-86.8%],93.2%(86.6%-96.7%),92.2%(85.3%-96.0%)in the intention-to-treat(ITT)analysis,and 80.9%(95%CI:71.7%-87.5%),94.0%(87.5%-97.2%),and 93.9%(87.4%-97.2%)in the per-protocol analysis.The ITT analysis showed a higher eradication rate in the VAT-10 and VAT-14 groups than in the BQT group(P=0.022 and P=0.046,respectively).The incidence of adverse events in the VAT-10 and VAT-14 groups was lower than in the BQT group(25.27%and 13.73%vs 37.62%,respectively;P<0.001).CONCLUSION VAT with a duration of 10 or 14 days achieves a higher eradication rate than the BQT,with a more tolerable safety profile in H.pylori-infected patients in Fujian.Huang XP et al.VAT for H.pylori eradication.

Effect of gastric microbiota on quadruple Helicobacter pylori eradication therapy containing bismuth

BACKGROUND Helicobacter pylori(H.pylori)is an important pathogen that can cause a variety of diseases.Yet,full eradication of H.pylori remains a significant challenge in clinical practice.H.pylori and other microbial communities have complex interactions in the unique gastric microecological environment.However,it is not clear whether the interactions have any effect on the therapeutic effect of H.pylori.AIM The aim was to investigate the characteristics of the gastric microbiota with H.pylori infection and the influence on the H.pylori eradication treatment.METHODS Patients with H.pylori infection underwent gastroscopy and received treatment for eradication.The prescription included esomeprazole 20 mg bid,Livzon Dele 220 mg bid,amoxicillin 1000 mg bid,and clarithromycin 500 mg bid for 14 d.Patients who did not respond to treatment and failed eradication were compared with those who achieved eradication by 1:2 propensity matching.Highthroughput sequencing of the gastric mucosal microbiota was performed,and the results were evaluated by alpha diversity analysis,beta diversity analysis,species correlation analysis,and metabolic pathway correlation analysis.RESULTS The eradication rate of all the patients was 95.5%(171/179).Twenty-four patients were enrolled in the study after propensity-matched scoring.There were eight cases in the failure group(patients who did not respond well to therapy)and 16 cases in the success group.The majority phyla in the two groups were the same,and included Proteobacteria,Bacteroides,Firmicutes,Actinomycetes,and Fusobacteria.The microbial diversity in the failure group had a decreasing trend(P=0.092)and the species abundance was significantly lower(P=0.031)compared with the success group.The high rate of H.pylori eradication was associated with Rhodococcus,Lactobacillus,and Sphingomonas,as they were significantly enriched in the successful group(P<0.05).Veronococcus and Cilium were enriched in the mucosa of chronic atrophic gastritis patients compared with chronic superficial gastritis patients(P=0.0466 and 0.0122,respectively).In both study groups,H.pylori was negatively correlated with other bacterial genera.More bacterial genera were directly related to H.pylori in the successful group compared with the failure group.CONCLUSION The effectiveness of quadruple H.pylori eradication therapy containing bismuth depended on gastric microbiota,and the high rate of H.pylori eradication was associated with the presence of Rhodococcus,Lactobacillus,and Sphingomonas.

Metabolic dynamics in chronic gastritis:Examining urinary profiles post Helicobacter pylori eradication

Chronic gastritis is the persistent and insidious inflammation of the gastric lining.Helicobacter pylori(H.pylori)has been identified as the most common cause of chronic gastritis and consequently elimination of H.pylori can lead to its cure.This editorial explores the use of urinary metabolic profiles before and after eradication to identify biomarkers that can aid in prognosis and treatment.Despite providing promising insights,there are limitations such as a small sample size(17 patients),a narrow treatment period of 2 wk,and treatment heterogeneity,which raise concerns.Nevertheless,these findings have opened a gateway to enhancing the treatment and prognosis of chronic gastritis through urinary metabolomics.

Standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori eradication

AIM: To compare the effectiveness of standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori (H. pylori ) eradication in a randomized, double-blinded, comparative clinical trial in China. METHODS: A total of 215 H. pylori -positive patients were enrolled in the study and randomly allocated into three groups: group A (n = 72) received a 10-d bismuth pectin quadruple therapy (20 mg rabeprazole bid , 1000 mg amoxicillin bid , 100 mg bismuth pectin qid , and 500 mg levofloxacin qd ); group B (n = 72) received the sequential therapy (20 mg omeprazole bid , 1000 mg amoxicillin bid , in 5 d, followed by 20 mg omeprazole bid , 500 mg tinidazole bid , 500 mg clarithromycin bid , for another 5 d); group C (n = 71) received a standard 1-wk triple therapy (20 mg omeprazole bid , 1000 mg amoxicillin bid , 500 mg clarithromycin bid ). After all these treatments, 20 mg omeprazole bid was administrated for 3 wk. H. pylori status was assessed by histology, 13C-urea breath test and rapid urease test at baseline and 4-6 wk after completion of treatment. Ulcer cicatrization was assessed by gastroscopy. χ 2 test (P < 0.05) was used to compare the eradication rates and ulcer cicatrisation rates among the three groups. RESULTS: The eradication rate was 83.33% (60/72) in group A, 88.89% (64/72) in group B, and 80.56% (58/71) in group C. The ulcer cicatrisation rate was 86.44% (51/59) in group A, 90.16% (55/61) in group B, and 84.91% (45/53) in group C. The sequential therapy yielded a higher eradication rate and ulcer cicatrisation rate than the standard triple and bismuth pectin quadruple therapies. Statistically, the eradication rate of group B was significantly different from groups A and C (P < 0.05), but the difference of ulcer cicatrisation rate and side effects was not statistically significant among the three groups (P > 0.05). The three protocols were generally well tolerated. CONCLUSION: The sequential therapy has achieved a significantly higher eradication rate, and is a more suitable first-line alternative protocol for anti-H. pylori infection compared with the standard triple and bismuth pectin quadruple therapies.

Management of Heart Failure with Reduced Ejection Fraction Globally and in Lebanon: Where Do SGLT-2is Stand?

Heart failure (HF) is a clinical syndrome due to structural and/or functional cardiac anomalies, accompanied by elevated natriuretic peptide levels and/or cardiogenic pulmonary or systemic congestion;severely compromising patients’ health, performance and quality of life. The advancement of novel treatment and their endorsement by international medical and scientific societies have shifted the treatment of HF with reduced ejection fraction (HFrEF) towards quadruple therapy: an angiotensin receptor-neprilysin inhibitor or an angiotensin-converting enzyme inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium/glucose co-transporter-2 inhibitor (SGLT2i). This paper reviews the available literature on state-of-the-art diagnostic and therapeutic advances in HFrEF, discusses landmark trials that shifted the paradigm towards quadruple therapy in HFrEF, visits the potential challenges in Lebanon and globally, proposes an algorithm for treatment introduction and sequencing in HFrEF and highlights clinical considerations for HFrEF management and patient education and follow-up. This practical guidance could serve cardiologists and other medical specialists in identifying clinical signs of HFrEF, diagnosing patients, referring them or prescribing the components of quadruple therapy, and offering medical advice and follow-up. We highlight the role of SGLT2is in HF management and their effectiveness in reducing rates of hospitalization for HF as well as cardiovascular deaths, with satisfactory safety profile.

Assessing of the Therapeutic Efficacy of These 2 Treatment Regimens in the Management of Helicobacter pylori Infection at Kinshasa

Introduction: Helicobacter pylori (Hp) infection is a worldwide public health problem. Unfortunately, its management poses a problem because of resistance to antibiotics. However, there are codified treatment protocols covering sequential and concomitant quadritherapy with regard to first-line probabilistic treatment. The objective of this study was to assess the therapeutic efficacy of these 2 treatment regimens in the management of Hp infection at Kinshasa. Methods: This was a mixed study, with documentary, descriptive and interventional approaches, carried out between September 1, 2018 and April 30, 2020. Results: Sixty-four patients were collected, including 36 men against 28 women with a sex ratio of 1H:1F;the mean age was 54 ± 16.5 years. There was an over-representation of senior patients (n = 29);an intermediate number of adult patients (n = 22) and a lower number of young patients (n = 13). 34 and 30 were respectively treated according to the concomitant and sequential regimens. Concomitant quadruple therapy offered an eradication rate of 91.2% compared to 56.7% for sequential quadruple therapy;concomitant treatment, advancing age and absence of risky behavior more quickly predicted the occurrence of eradication success. Conclusion: The present study showed superiority of concomitant quadruple therapy over sequential quadruple therapy in first-line treatment. Alcohol with active smoking had a negative influence, while concomitant quadruple therapy, advancement in age had a positive influence on the success of the eradication of Hp infection.

Current status of Helicobacter pylori eradication and risk factors for eradication failure

BACKGROUND The Helicobacter pylori(H.pylori)eradication rate is decreasing in the general population of China.AIM To evaluate the H.pylori eradication status in real-world clinical practice and to explore factors related to eradication failure.METHODS Patients with H.pylori infection who were treated with standard 14-d quadruple therapy and received a test of cure at a provincial medical institution between June 2018 and May 2019 were enrolled.Demographic and clinical data were recorded.Eradication rates were calculated and compared between regimens and subgroups.Multivariate analysis was performed to identify predictors of eradication failure.RESULTS Of 2610 patients enrolled,eradication was successful in 1999(76.6%)patients.Amoxicillin-containing quadruple regimens showed a higher eradication rate than other quadruple therapy regimens(83.0%vs 69.0%,P<0.001).The quadruple therapy containing amoxicillin plus clarithromycin achieved the highest eradication rate(83.5%).Primary therapy had a higher eradication rate than rescue therapy(78.3%vs 66.5%,P<0.001).In rescue therapy,the amoxicillinand furazolidone-containing regimens achieved the highest eradication rate(80.8%).Esomeprazole-containing regimens showed a higher eradication rate than those containing other proton pump inhibitors(81.8%vs 74.9%,P=0.001).Multivariate regression analysis found that older age,prior therapy,and use of omeprazole or pantoprazole were associated with an increased risk of eradication CONCLUSION The total eradication rate is 76.6%.Amoxicillin-containing regimens are superior to other regimens.Age,prior therapy,and use of omeprazole or pantoprazole are independent risk factors for eradication failure.

Dual therapy for Helicobacter pylori infection

Bismuth-containing quadruple therapy(BQT)has long been recommended for Helicobacter pylori(H.pylori)eradication in China.Meanwhile,in the latest national consensus in China,dual therapy(DT)comprising an acid suppressor and amoxicillin has also been recommended.In recent years,the eradication rate of H.pylori has reached>90%using DT,which has been used not only as a first-line treatment but also as a rescue treatment.Compared with BQT,DT has great potential for H.pylori eradication;however,it has some limitations.This review summarizes the development of DT and its application in H.pylori eradication.The H.pylori eradication rates of DT were comparable to or even higher than those of BQT or standard triple therapy,especially in the first-line treatment.The incidence of adverse events associated with DT was lower than that with other therapies.Furthermore,there were no significant differences in the effects of dual and quadruple therapies on gastrointestinal microecology.In the short term,H.pylori eradication causes certain fluctuations in the gastrointestinal microbiota;however,in the long term,the gastrointestinal microbiota eventually returns to its normal state.In the penicillin-naïve population,patients receiving DT have a high eradiation rate,better compliance,lower incidence of adverse reactions,and lower primary and secondary resistance to amoxicillin.These findings suggest the safety,efficacy,and potential of DT for H.pylori eradication.

Efficacy and safety of triple therapy containing berberine,amoxicillin,and vonoprazan for Helicobacter pylori initial treatment:A randomized controlled trial

Background:With the development of traditional Chinese medicine research,berberine has shown good efficacy and safety in the eradication of Helicobacter pylori(H.pylori).The present study aimed to evaluate the efficacy and safety of triple therapy containing berberine,amoxicillin,and vonoprazan for the initial treatment of H.pylori.Methods:This study was a single-center,open-label,parallel,randomized controlled clinical trial.Patients with H.pylori infection were randomly(1:1:1)assigned to receive berberine triple therapy(berberine 500 mg,amoxicillin 1000 mg,vonoprazan 20 mg,A group),vonoprazan quadruple therapy(vonoprazan 20 mg,amoxicillin 1000 mg,clarithromycin 500 mg,colloidal bismuth tartrate 220 mg,B group),or rabeprazole quadruple therapy(rabeprazole 10 mg,amoxicillin 1000 mg,clarithromycin 500 mg,colloidal bismuth tartrate 220 mg,C group).The drugs were taken twice daily for 14 days.The main outcome was the H.pylori eradication rate.The secondary outcomes were symptom improvement rate,patient compliance,and incidence of adverse events.Furthermore,factors affecting the eradication rate of H.pylori were further analyzed.Results:A total of 300 H.pylori-infected patients were included in this study,and 263 patients completed the study.An intention-to-treat(ITT)analysis showed that the eradication rates of H.pylori in berberine triple therapy,vonoprazan quadruple therapy,and rabeprazole quadruple therapy were 70.0%(70/100),77.0%(77/100),and 69.0%(69/100),respectively.The per-protocol(PP)analysis showed that the eradication rates of H.pylori in these three groups were 81.4%(70/86),86.5%(77/89),and 78.4%(69/88),respectively.Both ITT analysis and PP analysis showed that the H.pylori eradication rate did not significantly differ among the three groups(P>0.05).In addition,the symptom improvement rate,overall adverse reaction rate,and patient compliance were similar among the three groups(P>0.05).Conclusions:The efficacy of berberine triple therapy for H.pylori initial treatment was comparable to that of vonoprazan quadruple therapy and rabeprazole quadruple therapy,and it was well tolerated.It could be used as one choice of H.pylori initial treatment.

Efficacy and safety of high-dose esomeprazole–amoxicillin dual therapy for Helicobacter pylori rescue treatment:a multicenter,prospective,randomized,controlled trial

Background:High-dose dual therapy(HDDT)with proton pump inhibitors(PPIs)and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori(H.pylori).This study aimed to compare the efficacy and safety of high-dose PPI-amoxicillin dual therapy and bismuth-containing quadruple therapy for H.pylori rescue treatment.Methods:This was a prospective,randomized,multicenter,non-inferiority trial.Patients recruited from eight centers who had failed previous treatment were randomly(1:1)allocated to two eradication groups:HDDT(esomeprazole 40 mg and amoxicillin 1000 mg three times daily;theHDDTgroup)and bismuth-containing quadruple therapy(esomeprazole 40 mg,bismuth potassium citrate 220 mg,and furazolidone 100 mg twice daily,combined with tetracycline 500 mg three times daily;the tetracycline,furazolidone,esomeprazole,and bismuth[TFEB]group)for 14 days.The primary endpoint was the H.pylori eradication rate.The secondary endpoints were adverse effects,symptom improvement rates,and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study.The HDDT group achieved eradication rates of 75.4%(248/329),81.0%(248/306),and 81.3%(248/305)asdetermined by the intention-to-treat(ITT),modified intention-totreat(MITT),and per-protocol(PP)analyses,respectively.The eradication rates were similar to those in the TFEB group:78.1%(257/329),84.2%(257/305),and 85.1%(257/302).The lower 95%confidence interval boundary(9.19%in the ITT analysis,9.21%in the MITT analysis,and9.73%in the PP analysis)was greater than the predefined non-inferiority margin of10%,establishing a non-inferiority of the HDDT group vs.the TFEB group.The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group(11.1%vs.26.8%,P<0.001).Symptom improvement rates and patients’compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy,with fewer adverse effects and good treatment compliance,suggesting HDDT as an alternative for H.pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov,NCT04678492.