This retrospective review of 402 patients treated for Helicobacter pylori in one Budapest unit compared eradication across regimens with and without bismuth and probiotics, and across three bismuth preparations given at 120 mg four times daily. Bismuth-containing regimens with a probiotic succeeded more often than those without, and the three bismuth preparations did not differ significantly. The study did not record adverse events or bismuth levels.
Key numbers
- Bismuth doses: bismuth oxide (commercial) 4 x 120 mg daily; bismuth citrate (pharmacy-compounded) 4 x 120 mg; compounded bismuth-metronidazole capsules containing 120 mg bismuth citrate and 375 mg metronidazole, 4 per day (Table 16, p. 17).
- Success by bismuth preparation: bismuth oxide 30/35 (85.7%), bismuth citrate 37/52 (71.2%), bismuth-metronidazole 28/31 (90.3%), p = 0.0670 (Table 9, p. 10).
- All bismuth-containing regimens with probiotic 64/73 (87.6%) versus without probiotic 31/45 (68.9%), p = 0.0124; in 14-day regimens 44/45 (97.8%) versus 3/7 (42.9%), p < 0.0001 (Table 8, p. 10).
- Clarithromycin-based triple therapy without additions: 127/171 (74.3%) (Table 7, p. 10).
Methods (brief)
Electronic records of H. pylori-positive patients (diagnosed histologically) treated between 2016 and 2024 were reviewed, with success judged by 14C breath test or stool antigen test. Regimens were grouped by base protocol, bismuth use, probiotic use and duration (7, 10 or 14 days), and success rates were compared statistically.
Evidence fitness
The study documents medicinal bismuth doses in routine European practice and treatment-success comparisons. It does not support any statement on bismuth safety, adverse effects or body burden, which were not collected, and it provides no information on dietary bismuth.
Limitations
Retrospective, single-center, non-randomized; physicians chose regimens. The paper states that no data on patient-reported outcomes were collected (p. 18). Some subgroups are very small (for example, 7 patients on 14-day bismuth regimens without probiotic).
Related evidence
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