Three‐day lansoprazole quadruple therapy for Helicobacter pylori‐positive duodenal ulcers: a randomized controlled study

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Abstract
Aim: To compare the efficacy and tolerability of a 3‐day quadruple therapy with a standard 7‐day triple therapy in eradicating Helicobacter pylori infection and healing duodenal ulcers.Methods: Patients with H. pylori‐positive duodenal ulcers were randomized to receive either lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 400 mg twice daily for 7 days (LCM‐7) or lansoprazole 30 mg, clarithromycin 500 mg, metronidazole 400 mg, and bismuth subcitrate 240 mg twice daily for 3 days (LCMB‐3). No pre‐ or post‐treatment acid suppression was used. Follow‐up endoscopy was performed at week 6.Results: A total of 118 patients were recruited. Sixty patients in the LCM‐7 group and 53 patients in the LCMB‐3 group returned for endoscopy. Intention‐to‐treat eradication rates were 87% and 86% (P=0.94) and per protocol eradication rates were 87% and 94% (P=0.29) in the LCM‐7 and LCMB‐3 groups, respectively. Per protocol and intention‐to‐treat ulcer healing rates were 98% and 98% in LCM‐7 and 100% and 91% in LCMB‐3, respectively. There were no significant differences in efficacy in relation to the initial metronidazole and clarithromycin susceptibility. Significant reduction in the duration of side‐effects was found in the LCMB‐3 group.Conclusion: The 3‐day quadruple therapy is highly effective, better tolerated and can be considered as a first‐line therapy in duodenal ulcer management.