Eradication Efficacy of Modified Dual Therapy Compared With Bismuth-Containing Quadruple Therapy as a First-Line Treatment of Helicobacter Pylori

Am J Gastroenterol. 2019 Mar;114(3):437-445. doi: 10.14309/ajg.0000000000000132.


Objectives: This study assessed the effectiveness, adverse events, patient adherence, and costs of modified dual therapy compared with bismuth-containing quadruple therapy for treating Helicobacter pylori infection in Chinese patients. We also sought to determine whether modified dual therapy could be used as an alternative first-line treatment for H. pylori infection.

Methods: A total of 232 H. pylori-infected, treatment-naive patients were enrolled in this open-label, randomized controlled clinical trial. Patients were randomly allocated into 2 groups: the 14-day modified dual therapy group and the bismuth-containing quadruple therapy group. Eradication rates, drug-related adverse events, patient compliance, and drug costs were compared between the 2 groups.

Results: The modified dual therapy group achieved eradication rates of 87.9%, 91.1%, and 91.1% as determined by the intention-to-treat, per-protocol, and modified intention-to-treat analyses, respectively. The eradication rates were similar compared with the bismuth-containing quadruple therapy group: 89.7%, 91.2%, and 90.4%. In addition, modified dual therapy ameliorated variations in the CYP2C19, IL-1B-511, and H. pylori VacA genotypes. There were no significant differences in the compliance rates between the 2 groups. The modified dual therapy group exhibited significantly less overall side effects compared with the bismuth-containing quadruple therapy group (P < 0.001). Furthermore, the cost of medications in the modified dual therapy was lower compared with that in the bismuth-containing quadruple therapy.

Conclusions: Modified dual therapy at high dose and administration frequency is equally effective and safer and less costly compared with bismuth-containing quadruple therapy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amoxicillin / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Ulcer Agents / therapeutic use*
  • Breath Tests
  • Carbon Isotopes
  • Clarithromycin / therapeutic use*
  • Drug Costs
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Esomeprazole / therapeutic use*
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Organometallic Compounds / therapeutic use*
  • Treatment Outcome
  • Urea


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Carbon Isotopes
  • Organometallic Compounds
  • Amoxicillin
  • Urea
  • Carbon-13
  • Clarithromycin
  • bismuth tripotassium dicitrate
  • Esomeprazole