Reports from the Canadian Helicobacter pylori Consensus Conference and from the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology advocate testing and eradicating H pylori in patients presenting with gastroduodenal ulcers. However, results of a survey indicated that 43% to 66% of American physicians also eradicate H pylori in patients with nonulcer dyspepsia. Over the years, many treatments have been tested for the eradication of H pylori. Among them, the so-called bismuth-based triple-therapy with colloidal bismuth subcitrate, metronidazole and tetracycline (BMT) has been extensively tested with success.
In a previous trial, a 14-day treatment with colloidal bismuth subcitrate 120 mg qid plus metronidazole 250 mg qid plus tetracycline 500 mg qid gave very good eradication rates of 82% and 90% by modified intent-to-treat (MITT) and per protocol analyses, respectively. The influence of metronidazole sensitivity on the eradication rate was, however, not assessed.
In an effort to increase the efficacy of the regimen, a proton pump inhibitor was added. Also, the treatment duration was reduced to seven days, and the amount of tetracycline was lowered to 1 g daily to increase gastrointestinal tolerance. This study, therefore, was designed to assess the efficacy and safety of a seven-day treatment for the eradication of H pylori with colloidal bismuth subcitrate 120 mg qid plus metronidazole 250 mg qid plus tetracycline 250 mg qid, all given 1 h before meals and at bedtime, in addition to omeprazole 20 mg bid with the morning and evening meals.