Research Article | | Peer-Reviewed

Multi-center Comparison of Rabeprazole and Esomeprazole Bismuth Quadruple Therapies in Treatment of Primary Helicobacter pylori Infection

Received: 27 May 2025     Accepted: 10 June 2025     Published: 25 June 2025
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Abstract

Object: Real-world study was chose to compare efficacies of rabeprazole and esomeprazole bismuth quadruple therapies in eradicating primary Helicobacter pylori infection, and accumulate evidence for choosing appropriate Helicobacter pylori eradicative therapy. Methods: Non-interventive, multi-center studies was conducted to collect patients who took proton pump inhibitor bismuth quadruple therapy from January 2019 to December 2023. Duration was 14 days. Patients were divided into rabeprazole or esomeprazole bismuth quadruple therapy. Helicobacter pylori were determined using 13C/14C urea breath test at least 4 weeks after completion of treatments. Results: Four hundred and sixty-seven patients were enrolled: 110 and 367 patients in rabeprazole and esomeprazole bismuth quadruple therapy respectively. Baseline variables were balanced between the two groups using a propensity score matching. 110 and 274 patients in rabeprazole and esomeprazole bismuth quadruple therapy respectively. Eradicative incidences were 82.7% (91/110) and 86.1% (236/276) in rabeprazole and esomeprazole bismuth quadruple therapy respectively, and and there was no significant difference (P > 0.05). Conclusions: Rabeprazole or esomeprazole bismuth quadruple therapy could be chose similarly for eradicating primary Helicobacter pylori infection.

Published in Science Discovery (Volume 13, Issue 3)
DOI 10.11648/j.sd.20251303.14
Page(s) 56-59
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Rabeprazole, Esomeprazole, Bismuth, Helicobacter pylori, Real-world Study

1.前言
幽门螺旋杆菌感染是慢性胃炎、消化性溃疡和胃癌等消化道疾病常见病因,且全球幽门螺杆菌(Helicobacter pylori,Hp)感染率高达50%。幽门螺杆菌感染诊治指南共识将根除幽门螺杆菌作为慢性胃炎、消化性溃疡、胃癌等疾病的重要防治策略。现国内外指南共识一致推荐幽门螺杆菌感染初治患者经验性治疗首选含质子泵抑制剂铋剂四联方案。虽然质子泵抑制剂铋剂四联方案与其他根除方案疗效是否有差异报道较多,如标准三联方案、伴同方案或序贯方案,但对不同质子泵抑制剂铋剂四联方案疗效是否有差异则报道较少。故采用真实世界研究方法比较雷贝拉唑与艾司奥美拉唑铋剂四联方案治疗幽门螺杆菌感染疗效差异,从而为幽门螺杆菌初治患者选用根除方案提供临床证据。
2.资料与方法
2.1.研究对象
采用非干预性多中心临床研究的设计方法,回顾性收集2019年1月-2023年12月期间乐山市人民医院等四家医疗机构幽门螺杆菌初治感染采用铋剂四联方案治疗患者。本研究获乐山市人民医院伦理委员会批准。
2.2.纳入标准
幽门螺杆菌初治患者,采用质子泵抑制剂铋剂四联方案,治疗天数均为14天,停药4周后进行13C/14C呼气试验复查根除效果。
2.3.排除标准
使用非质子泵抑制剂铋剂四联方案;样本量小于100例的质子泵抑制剂铋剂四联方案。
2.4.患者分组
因奥美拉唑、泮托拉唑、艾普拉唑与兰索拉唑铋剂四联方案各组样本量均低于100例,故本研究仅纳入雷贝拉唑与艾司奥美拉唑两种质子泵抑制剂,患者分为为雷贝拉唑与艾司奥美拉唑铋剂四联两组。
2.5.观察指标
2.5.1.基线资料
年龄,性别。
2.5.2.有效性指标
幽门螺杆菌根除率。
2.6.统计方法
采用R软件“MatchIt”进行倾向性评分匹配,首先采用logistic回归估计每个样本的倾向性评分值,然后采用近邻匹配法进行样本匹配,匹配过程采用有放回进行采样,利用PS值均衡组间协变量后需要对均衡性进行检验。GraphPad 8.0软件对数据进行统计学分析。定量资料满足正态性,则结果以 ±SD表示,否则以M(Q25, Q75)表示;两组数据如符合方差齐性与正态性,则采用参数检验t检验,否则选用非参数检验Mann-Whitney 检验;分类资料采用χ2检验。P<0.05为差异有统计学意义。
3.结果
3.1.基线资料
共纳入477例患者,其中雷贝拉唑铋剂四联组110例,艾司奥美拉唑铋剂四联组367例,基线不均衡。将基线资料年龄与性别作为预测变量按倾向性评分法匹配,雷贝拉唑铋剂四联组110例,艾司奥美拉唑铋剂四联组274例,匹配后两组基线均衡,差异无统计学意义(P>0.05,表1)。
表1 倾向性评分匹配法前后纳入纳入患者基线资料。

基线指标

匹配前

匹配后

雷贝拉唑铋剂四联组(110例)

艾司奥美拉唑铋剂四联组(367例)

统计值

P

雷贝拉唑铋剂四联组(110例)

艾司奥美拉唑铋剂四联组(274例)

统计值

P

性别(男/女,例)

35/75

150/217

χ2=2.9

P=0.08

35/75

110/164

χ2=2.3

P=0.13

年龄(M(Q25, Q75),岁)

52(44, 58)

55(47, 64)

U=16756

P=0.007

52(44, 58)

54(46, 60)

U=13259

P=0.07

3.2.雷贝拉唑与艾司奥美拉唑铋剂四联方案的幽门螺杆菌根除率比较
经14天疗程治疗后,雷贝拉唑组铋剂四联组91例患者幽门螺杆菌检测呈阴性,根除率为82.7%(91/110),艾司奥美拉唑铋剂四联组236例患者幽门螺杆菌检测呈阴性,根除率为86.1%(236/274),两组治疗效果无统计学差异(P>0.05,表2)。
表2 雷贝拉唑与艾司奥美拉唑铋剂四联方案的幽门螺杆菌根除率比较。

组别

根除例数

未根除例数

统计值

P值

雷贝拉唑铋剂四联组

91

19

χ2=0.72

P=0.40

艾司奥美拉唑铋剂四联组

236

38

4.讨论
目前临床常用第二代质子泵抑制剂雷贝拉唑或艾司奥美拉唑,因第二代质子泵抑制剂比第一代质子泵抑制剂具有更强抑酸效果与更长作用持续时间,更强抑酸能力可能意味着根除方案疗效更佳。随机对照研究发现第一代质子泵抑制剂奥美拉唑铋剂四联方案低于第二代质子泵抑制剂雷贝拉唑铋剂四联方案似乎印证上述观点。但随机对照研究因入排标准而纳入人群限制较多,用药条件控制严格,使得研究结果的内部真实性较高,外部真实性却较差,因此无法确定在真实临床实践中的可推广性。真实世界研究(Real-world Study,RWS)则很好地弥补随机对照研究的上述不足。本研究发现雷贝拉唑铋剂四联方案与艾司奥美拉唑铋剂四联方案显示类似的幽门螺杆菌根除率(82.7% vs 86.1%)。本研究结果与雷贝拉唑与艾司奥美拉唑铋剂四联方案的随机对照研究结果类似(87.1% vs 85.6%)。综合随机对照研究与真实世界研究数据来看,雷贝拉唑与艾司奥美拉唑铋剂四联方案对幽门螺杆菌感染初治患者的根除率可能介于80%到90%之间,处于临床可接受范围之内
本研究局限性:(1)因样本量小,未比较雷贝拉唑与艾司奥美拉唑剂量不同是否对幽门螺杆菌根除率有影响,本研究雷贝拉唑有10mg与20mg两种剂量,艾司奥美拉唑亦有20mg和40mg两种剂量。研究认为提高质子泵抑制剂剂量可提高铋剂四联方案根除率。(2)因样本量小,未比较不同铋剂(枸橼酸铋钾与胶体果胶铋)、不同抗菌药物组合间幽门螺杆菌根除率差异。(3)本回顾性研究发现乐山市多数区县医疗机构未使用指南推荐铋剂四联方案,造成奥美拉唑、泮托拉唑、艾普拉唑与兰索拉唑铋剂四联方案样本量过少无法进行纳入分析,故无法直接对比常用质子泵抑制剂铋剂四联方案根除率差异。(4)部分患者治疗后未进行复查,亦造成部分数据缺失影响获得最真实的根除率。
综上所述,乐山市幽门螺杆菌初治患者经验性选择雷贝拉唑或艾司奥美拉唑铋剂四联方案似乎同样有效,两种方案的根除率处于可接受范围但都尚未超过90%。真实世界研究中抑酸作用更强的钾离子竞争性酸阻滞剂铋剂四联方案疗效是否比质子泵抑制剂铋剂四联方案更高且能超过90%,仍需要进一步研究。
基金项目
乐山市科技局重点科技计划项目(22SZD064)。
参考文献
[1] Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report [J]. Gut, 2022, 71:1724-1762.
[2] 中华医学会消化病学分会幽门螺杆菌学组. 2022中国幽门螺杆菌感染治疗指南 [J]. 胃肠病学, 2022, 27(3): 150-162.
[3] Asim M, Baqai K, Abbas Z, et al. Addition of bismuth to standard triple therapy for Helicobacter pylori eradication: a randomised controlled trial [J]. J Pak Med Assoc, 2020, 70(8): 1334-1339.
[4] Kadayifci A, Uygun A, Polat Z, et al. Comparison of bismuth-containing quadruple and concomitant therapies as a first-line treatment option for Helicobacter pylori[J]. Turk J Gastroenterol, 2012, 23(1):8-13.
[5] Hsu P I, Tsay F W, Graham D Y, et al. Equivalent Efficacies of Reverse Hybrid and Bismuth Quadruple Therapies in Eradication of Helicobacter pylori Infection in a Randomized Controlled Trial [J]. Clin Gastroenterol Hepatol, 2018, 16(9): 1427-1433.
[6] Koroglu M, Ayvaz M A, Ozturk M A. The efficacy of bismuth quadruple therapy, sequential therapy, and hybrid therapy as a first-line regimen for Helicobacter pylori infection compared with standard triple therapy [J]. Niger J Clin Pract, 2022, 25(9): 1535-1541.
[7] Mcnicholl A G, Linares P M, Nyssen O P, et al. Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection [J]. Aliment Pharmacol Ther, 2012, 36(5): 414-425.
[8] 刘伟峰,田继红,刘景霞. 雷贝拉唑钠四联方案治疗幽门螺杆菌阳性十二指肠溃疡的疗效观察 [J]. 中国医院用药评价与分析, 2017, 17(6): 785-786, 789.
[9] 刘佐相,龙子临,杨智荣,等. 临床干预措施效力-效果差距弥合的方法学研究进展(二):增强临床试验结果的外推性[J]. 中华流行病学杂志, 2024, 45(4): 579-584.
[10] 廖珊妹,张小娟,张晓薇,等. 真实世界研究的方法学进展 [J]. 中国食品药品监管, 2021(4): 32-43.
[11] 张鑫赫,曾子露,王雪,等. 雷贝拉唑与艾司奥美拉唑钠治疗幽门螺杆菌感染疗效及安全性比较 [J]. 中国实用内科杂志, 2021, 41(10): 885-889.
[12] Graham D Y, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy [J]. Helicobacter, 2007, 12(4): 275-278.
[13] Kyoungwon Jung, Sam Ryong Jee, Moon Won Lee, et al. Comparison of Helicobacter pylori eradication rates between 7 and 14 days of tailored therapy according to clarithromycin resistance test: A randomized, multicenter, non-inferiority study [J]. Helicobacter. 2024, 29(3): e13084.
[14] Faming Yang, Baiyang Yu, Lang Qin, et al. A randomized clinical study on the efficacy of vonoprazan combined with amoxicillin duo regimen for the eradication of Helicobacter pylori [J]. Medicine (Baltimore). 2023 Oct 13; 102(41): e35610.
[15] Baojun Suo, Xueli Tian, Hua Zhang, et al. Bismuth, esomeprazole, metronidazole, and minocycline or tetracycline as a first-line regimen for Helicobacter pylori eradication: A randomized controlled trial [J]. Chin Med J (Engl), 2023, 136(8): 933-940.
[16] Kuo-Tung Hung, Shih-Cheng Yang, Cheng-Kun Wu, et al. Eradication Rates for Esomeprazole and Lansoprazole-Based 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Anti- Helicobacter pylori Treatment in Real World Clinical Practice [J]. Infect Drug Resist 2021, 14: 1239-1246.
[17] Wang Y, Dai X, Gao C, et al. Network meta-analysis of different dosages of esomeprazole and rabeprazole for the treatment of Helicobacter pylori [J]. Helicobacter, 2023, 28(2): e12948.
作者简介

蒲强红(1981-12),男,汉族,四川眉山,副主任药师,博士,研究方向:临床药学,办公室电话:0833-2119476,E-mail:243937683@qq.com

References
[1] Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report [J]. Gut, 2022, 71:1724-1762.
[2] 中华医学会消化病学分会幽门螺杆菌学组. 2022中国幽门螺杆菌感染治疗指南 [J]. 胃肠病学, 2022, 27(3): 150-162.
[3] Asim M, Baqai K, Abbas Z, et al. Addition of bismuth to standard triple therapy for Helicobacter pylori eradication: a randomised controlled trial [J]. J Pak Med Assoc, 2020, 70(8): 1334-1339.
[4] Kadayifci A, Uygun A, Polat Z, et al. Comparison of bismuth-containing quadruple and concomitant therapies as a first-line treatment option for Helicobacter pylori[J]. Turk J Gastroenterol, 2012, 23(1):8-13.
[5] Hsu P I, Tsay F W, Graham D Y, et al. Equivalent Efficacies of Reverse Hybrid and Bismuth Quadruple Therapies in Eradication of Helicobacter pylori Infection in a Randomized Controlled Trial [J]. Clin Gastroenterol Hepatol, 2018, 16(9): 1427-1433.
[6] Koroglu M, Ayvaz M A, Ozturk M A. The efficacy of bismuth quadruple therapy, sequential therapy, and hybrid therapy as a first-line regimen for Helicobacter pylori infection compared with standard triple therapy [J]. Niger J Clin Pract, 2022, 25(9): 1535-1541.
[7] Mcnicholl A G, Linares P M, Nyssen O P, et al. Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection [J]. Aliment Pharmacol Ther, 2012, 36(5): 414-425.
[8] 刘伟峰,田继红,刘景霞. 雷贝拉唑钠四联方案治疗幽门螺杆菌阳性十二指肠溃疡的疗效观察 [J]. 中国医院用药评价与分析, 2017, 17(6): 785-786, 789.
[9] 刘佐相,龙子临,杨智荣,等. 临床干预措施效力-效果差距弥合的方法学研究进展(二):增强临床试验结果的外推性[J]. 中华流行病学杂志, 2024, 45(4): 579-584.
[10] 廖珊妹,张小娟,张晓薇,等. 真实世界研究的方法学进展 [J]. 中国食品药品监管, 2021(4): 32-43.
[11] 张鑫赫,曾子露,王雪,等. 雷贝拉唑与艾司奥美拉唑钠治疗幽门螺杆菌感染疗效及安全性比较 [J]. 中国实用内科杂志, 2021, 41(10): 885-889.
[12] Graham D Y, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy [J]. Helicobacter, 2007, 12(4): 275-278.
[13] Kyoungwon Jung, Sam Ryong Jee, Moon Won Lee, et al. Comparison of Helicobacter pylori eradication rates between 7 and 14 days of tailored therapy according to clarithromycin resistance test: A randomized, multicenter, non-inferiority study [J]. Helicobacter. 2024, 29(3): e13084.
[14] Faming Yang, Baiyang Yu, Lang Qin, et al. A randomized clinical study on the efficacy of vonoprazan combined with amoxicillin duo regimen for the eradication of Helicobacter pylori [J]. Medicine (Baltimore). 2023 Oct 13; 102(41): e35610.
[15] Baojun Suo, Xueli Tian, Hua Zhang, et al. Bismuth, esomeprazole, metronidazole, and minocycline or tetracycline as a first-line regimen for Helicobacter pylori eradication: A randomized controlled trial [J]. Chin Med J (Engl), 2023, 136(8): 933-940.
[16] Kuo-Tung Hung, Shih-Cheng Yang, Cheng-Kun Wu, et al. Eradication Rates for Esomeprazole and Lansoprazole-Based 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Anti- Helicobacter pylori Treatment in Real World Clinical Practice [J]. Infect Drug Resist 2021, 14: 1239-1246.
[17] Wang Y, Dai X, Gao C, et al. Network meta-analysis of different dosages of esomeprazole and rabeprazole for the treatment of Helicobacter pylori [J]. Helicobacter, 2023, 28(2): e12948.
Cite This Article
  • APA Style

    Pu, Q., Deng, Y., Zhou, J., Luo, M. (2025). Multi-center Comparison of Rabeprazole and Esomeprazole Bismuth Quadruple Therapies in Treatment of Primary Helicobacter pylori Infection. Science Discovery, 13(3), 56-59. https://doi.org/10.11648/j.sd.20251303.14

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    ACS Style

    Pu, Q.; Deng, Y.; Zhou, J.; Luo, M. Multi-center Comparison of Rabeprazole and Esomeprazole Bismuth Quadruple Therapies in Treatment of Primary Helicobacter pylori Infection. Sci. Discov. 2025, 13(3), 56-59. doi: 10.11648/j.sd.20251303.14

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    AMA Style

    Pu Q, Deng Y, Zhou J, Luo M. Multi-center Comparison of Rabeprazole and Esomeprazole Bismuth Quadruple Therapies in Treatment of Primary Helicobacter pylori Infection. Sci Discov. 2025;13(3):56-59. doi: 10.11648/j.sd.20251303.14

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  • @article{10.11648/j.sd.20251303.14,
      author = {Qiang-Hong Pu and Yuan-Qian Deng and Jian Zhou and Ming-Xing Luo},
      title = {Multi-center Comparison of Rabeprazole and Esomeprazole Bismuth Quadruple Therapies in Treatment of Primary Helicobacter pylori Infection},
      journal = {Science Discovery},
      volume = {13},
      number = {3},
      pages = {56-59},
      doi = {10.11648/j.sd.20251303.14},
      url = {https://doi.org/10.11648/j.sd.20251303.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sd.20251303.14},
      abstract = {Object: Real-world study was chose to compare efficacies of rabeprazole and esomeprazole bismuth quadruple therapies in eradicating primary Helicobacter pylori infection, and accumulate evidence for choosing appropriate Helicobacter pylori eradicative therapy. Methods: Non-interventive, multi-center studies was conducted to collect patients who took proton pump inhibitor bismuth quadruple therapy from January 2019 to December 2023. Duration was 14 days. Patients were divided into rabeprazole or esomeprazole bismuth quadruple therapy. Helicobacter pylori were determined using 13C/14C urea breath test at least 4 weeks after completion of treatments. Results: Four hundred and sixty-seven patients were enrolled: 110 and 367 patients in rabeprazole and esomeprazole bismuth quadruple therapy respectively. Baseline variables were balanced between the two groups using a propensity score matching. 110 and 274 patients in rabeprazole and esomeprazole bismuth quadruple therapy respectively. Eradicative incidences were 82.7% (91/110) and 86.1% (236/276) in rabeprazole and esomeprazole bismuth quadruple therapy respectively, and and there was no significant difference (P > 0.05). Conclusions: Rabeprazole or esomeprazole bismuth quadruple therapy could be chose similarly for eradicating primary Helicobacter pylori infection.},
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Multi-center Comparison of Rabeprazole and Esomeprazole Bismuth Quadruple Therapies in Treatment of Primary Helicobacter pylori Infection
    AU  - Qiang-Hong Pu
    AU  - Yuan-Qian Deng
    AU  - Jian Zhou
    AU  - Ming-Xing Luo
    Y1  - 2025/06/25
    PY  - 2025
    N1  - https://doi.org/10.11648/j.sd.20251303.14
    DO  - 10.11648/j.sd.20251303.14
    T2  - Science Discovery
    JF  - Science Discovery
    JO  - Science Discovery
    SP  - 56
    EP  - 59
    PB  - Science Publishing Group
    SN  - 2331-0650
    UR  - https://doi.org/10.11648/j.sd.20251303.14
    AB  - Object: Real-world study was chose to compare efficacies of rabeprazole and esomeprazole bismuth quadruple therapies in eradicating primary Helicobacter pylori infection, and accumulate evidence for choosing appropriate Helicobacter pylori eradicative therapy. Methods: Non-interventive, multi-center studies was conducted to collect patients who took proton pump inhibitor bismuth quadruple therapy from January 2019 to December 2023. Duration was 14 days. Patients were divided into rabeprazole or esomeprazole bismuth quadruple therapy. Helicobacter pylori were determined using 13C/14C urea breath test at least 4 weeks after completion of treatments. Results: Four hundred and sixty-seven patients were enrolled: 110 and 367 patients in rabeprazole and esomeprazole bismuth quadruple therapy respectively. Baseline variables were balanced between the two groups using a propensity score matching. 110 and 274 patients in rabeprazole and esomeprazole bismuth quadruple therapy respectively. Eradicative incidences were 82.7% (91/110) and 86.1% (236/276) in rabeprazole and esomeprazole bismuth quadruple therapy respectively, and and there was no significant difference (P > 0.05). Conclusions: Rabeprazole or esomeprazole bismuth quadruple therapy could be chose similarly for eradicating primary Helicobacter pylori infection.
    VL  - 13
    IS  - 3
    ER  - 

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Author Information
  • Department of Pharmacy, The People’s Hospital of Leshan, Leshan City, China

    Biography: 蒲强红(1981-12),男,汉族,四川眉山,副主任药师,博士,研究方向:临床药学,办公室电话:0833-2119476,E-mail:243937683@qq.com

  • Department of Pharmacy, The People’s Hospital of Jiajiang, Leshan City, China

  • Department of Pharmacy, E Mei Shan City People’s Hospital, Leshan City, China

  • Department of Pharmacy, The People’s Hospital of Muchuan, Leshan City, China

  • Table 1

    表1 倾向性评分匹配法前后纳入纳入患者基线资料。

  • Table 2

    表2 雷贝拉唑与艾司奥美拉唑铋剂四联方案的幽门螺杆菌根除率比较。