Abstract
Objective: Helicobacter pylori is the primary agent causing peptic ulcer, therefore imposing a significant impact on health elated quality of life, consequently affecting nearly 50% of global population. The objective of this study is to determine and assess the effectiveness of triple therapy versus bismuth containing quadruple therapy for eradication of peptic ulcer disease due to H. pylori.
 Methods: A prospective randomized observational study was conducted at Princess Esra Hospital, Department of Gastroenterology for a period of 6 months. A total of 100 patients were randomly allocated in tow groups. The data were assessed using various parameters. H. pylori eradication was validated using rapid urease test done at the start treatment 4 weeks after the completion.
 Results: A total of 100 patients were recruited in the study. In triple therapy group medication adherence rate was found to be 82% in triple and 92% in quadruple therapy. The eradication rate was assessed using Chi-square test it was 82% and 97% in triple and quadruple therapy group, respectively. Hence, the difference was found to be statistically significant value <0.005. In addition, increased recurrence rate has been observed in triple therapy (17%) in contrast with quadruple therapy (2%).
 Conclusion: Addition of bismuth to significant triple therapy improves cure rates with minimal side effects. Interestingly, we observed that when bismuth was added, it produced a significant higher eradication rate (97%) when compared with standard triple therapy (82%). According to our study, bismuth is highly effective treatment of peptic ulcer disease.
Highlights
Helicobacter pylori is one of the most prevalent pathogens which affects nearly 50% of population across the world [1,2]
We evaluated whether addition of bismuth to the standard triple therapy could be effective in terms of treatment and eradication rates
Quadruple therapy group consists of 29% of male and 21% of female, the most prevailing age was around 29–38 years (Table 1)
Summary
Helicobacter pylori is one of the most prevalent pathogens which affects nearly 50% of population across the world [1,2]. The prevalence of pylori infection in India is nearly around 80% mostly occurring in rural population [3]. As soon as pylori resides in the stomach causing infection, it can constantly live for more than a decade in the acidic pH where they distort gastric mucosa, transform the secretion pattern of hormones, inducing peptic ulcer disease [6]. Almost all consensus and clinical guidelines approved the use of standard triple therapy regimen consisting of proton-pump inhibitor and two antimicrobial agents as first-line therapy for eradication of pylori [7,8,9]. A unique antibiotic regimen is essential to further enhance eradication rate with least possible resistance
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