Evaluation of eradication efficacy and optimization strategies for Helicobacter pylori infection based on real-world data: a multivariable retrospective study.

OBJECTIVE

Based on real-world clinical data, this study aims to evaluate the differences in eradication efficacy among various H. pylori treatment regimens and the impact of prescription appropriateness on treatment outcomes.

METHODS

This single-center retrospective study included 897 patients with confirmed H. pylori infection (September 2022-September 2025). Eradication rates were compared among dual, triple, and bismuth-containing quadruple therapies, stratified by prescription appropriateness per 2022 Chinese guidelines. Multivariable logistic regression and stratified analyses were performed to assess factors associated with eradication success and follow-up adherence.

RESULTS

Overall ITT and PP eradication rates were 79.04 and 90.23%, respectively. Quadruple therapy achieved the highest rates (ITT: 81.42%; PP: 93.76%), outperforming dual and triple therapies. Prescription appropriateness significantly affected eradication in the quadruple therapy group (p < 0.01). In quadruple therapy, female was associated with higher eradication success (OR = 2.53, 95% CI: 1.15-5.73). In the inappropriate dual therapy subgroup, amoxicillin dose (<2.0 g vs. ≥2.0 g/day) did not significantly alter eradication rates. Older patients and those using TCM demonstrated better follow-up compliance.

CONCLUSION

Clinical practice should prioritize guideline-recommended regimens and standards; however, actual eradication effectiveness may vary depending on the regimen selected. Among these, bismuth-containing quadruple therapy should be the first-line treatment of choice and should be used in strict accordance with guideline standards.