Second-line bismuth-containing quadruple therapy for eradication and impact of diabetes.

Aim: To investigate (. ) eradication rates using second-line bismuth-containing quadruple therapy and to identify predictors of eradication failure.

Methods: This study included 636 patients who failed first-line triple therapy and received 7 d of bismuth-containing quadruple therapy between January 2005 and December 2015. We retrospectively demonstrated . eradication rates with respect to the year of therapy as well as demographic and clinical factors. . eradication was confirmed by a C-urea breath test or a rapid urease test at least 4 wk after the completion of bismuth-based quadruple therapy: proton pump inhibitor, metronidazole, bismuth, and tetracycline.

Results: The overall eradication rates by intention-to-treat analysis and per-protocol analysis were 73.9% (95%CI: 70.1%-77.4%) and 94.5% (95%CI: 92.4%-96.5%), respectively. Annual eradication rates from 2005 to 2015 were 100.0%, 92.9%, 100.0%, 100.0%, 100.0%, 97.4%, 100.0%, 93.8%, 84.4%, 98.9%, and 92.5%, respectively, by per-protocol analysis. A multivariate analysis showed that diabetes mellitus (OR = 3.99, 95%CI: 1.56-10.20, = 0.004) was associated with . eradication therapy failure.

Conclusion: The second-line bismuth-containing quadruple therapy for . infection is still effective in Korea, and diabetes mellitus is suggested to be a risk factor for eradication failure.