How important is compliance in Helicobacter pylori treatment?

Background: Helicobacter pylori (H. pylori) infection is one of the most common infections affecting humanity. As the level of development and socio-economic status of countries decreases, the prevalence of H. pylori infection increases. Although numerous H. pylori eradication regimens have been tested in recent years, the desired level of eradication success has not been achieved. In this study, we aimed to evaluate the effectiveness of alternative treatment protocols. Methods: Patients who presented to our clinic between 2023 and 2024 were included in the study. The patient groups were treated with Rabeprazole (R), Metronidazole (M), Amoxicillin (A), and Bismuth (B) (RMAB), or with Esomeprazole (E), Metronidazole (M), Tetracycline (T), and Bismuth (B) (EMTB) regimens. Patients who were resistant to both RMAB and EMTB treatment protocols received quintuple therapy with RTAMB and ETAMB. All patients were thoroughly informed about their treatment process, management of side effects, and adherence to the therapy. Results: A total of 611 patients who received H. pylori treatment were included in the study. Of the participants, 60.7% were women, and the mean age was 53.7 ± 15.2 years. For post-treatment response evaluation, 73.5% (n = 449) of the patients returned to our clinic. The overall H. pylori eradication success rate for the entire patient group was 49.6%. The success rates for patients receiving RMAB and EMTB treatments were 48.2% and 51.3%, respectively. Among the group of patients who were under controlled supervision and had optimal treatment compliance (n = 449), the success rates for the RMAB and EMTB treatments were found to be 66.9% and 68.5%, respectively. A total of 105 patients who were resistant to the RMAB and EMTB treatments were given RTAMB and ETAMB therapy. Of these patients, 96.2% complied with the treatment and underwent a response evaluation. The eradication success rates for patients treated with the RTAMB and ETAMB protocols were 65.6% and 67.6%, respectively. Conclusion: In this study, we demonstrated that bismuth-based quintuple therapy can be used as an alternative to bismuth-based quadruple therapies and other high-risk treatments. However, we also highlighted the critical importance of treatment adherence.