Korean J Helicobacter Up Gastrointest Res.  2021 Mar;21(1):48-58. 10.7704/kjhugr.2020.0052.

A 10- or 14-day Bismuth-containing Quadruple Therapy as a First-line Helicobacter pylori Eradication Therapy: A Systematic Review and Meta-analysis

  • 1Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
  • 2Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
  • 3Department of Internal Medicine, Seoul National University Hospital Gangnam Center, Seoul, Korea
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 5Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
  • 7Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 8Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 9Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
  • 10Department of Gastroenterology, Center for Gastric Cancer, Kyungpook National University Hospital Chilgok Hospital, Daegu, Korea
  • 11Department of Gastroenterology, School of Medicine, Kyungpook National University, Daegu, Korea
  • 12Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
  • 13Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
  • 14Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 15Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
  • 16Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea


The eradication rate of the first-line standard triple therapy (STT) for Helicobacter pylori (H. pylori) infection has decreased since 2000; therefore, other first-line therapies are required. This study was aimed at investigating the efficacy of bismuth-containing quadruple therapy (PBMT) for first-line H. pylori eradication compared to STT, sequential therapy (SQT), and concomitant therapy (CT).
Materials and Methods
The Ovid-MEDLINE, Koreamed, EMBASE, KMBASE, and Cochrane Library databases were searched from January 2008 to July 2018. All identified randomized controlled trials (RCTs) comparing PBMT and non-PBMT for first-line H. pylori eradication therapy were included in the final analysis.
A total of 3,653 patients from seven RCTs were enrolled. The pooled eradication rates of PBMT by intention-to-treat (ITT) and per-protocol (PP) analyses were 82.1% (95% CI, 68.2~90.8%) and 88.8% (95% CI, 77.1~94.9%), respectively. However, no statistically significant difference was observed in eradication rates of the 10- or 14-day PBMT as compared to 14-day STT, 10-day SQT, and 10-day CT in ITT and PP analyses. PBMT was significantly higher in adverse events than in the other eradication regimens (RR, 1.64; 95% CI, 1.11~2.44). Considerable heterogeneity in adverse events was observed among studies (χ2=88.7; P<0.001, I2=93%).
PBMT can be the first-line treatment for H. pylori eradication in Korea when other first-line options, including STT, SQT, or CT, are unavailable due to their high adverse event rates.


Adverse effects; Bismuth tripotassium dicitrate; Disease eradication; Meta-analysis
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