Efficacy Comparison and Analysis of Influencing Factors of High-Dose Dual Therapy vs. Bismuth-Containing Quadruple Therapy for Helicobacter pylori Infection in Elderly Patients in Hainan Province

Efficacy Comparison and Analysis of Influencing Factors of High-Dose Dual Therapy vs. Bismuth-Containing Quadruple Therapy for Helicobacter pylori Infection in Elderly Patients in Hainan Province | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy Comparison and Analysis of Influencing Factors of High-Dose Dual Therapy vs. Bismuth-Containing Quadruple Therapy for Helicobacter pylori Infection in Elderly Patients in Hainan Province Xiao Zhong, PingPing Li, Daya Zhang, Chen Chen, Yan-ting Lv, Xianfeng Huang, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8173102/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To compare the efficacy of high-dose dual therapy and bismuth-containing quadruple therapy in the treatment of Helicobacter pylori (H. pylori) infection in the elderly aged ≥ 60 years in Hainan Province, and to analyze the effects of gender, hypertension, diabetes mellitus, coronary heart disease, and anxiety status on therapeutic outcomes, so as to provide a reference for the precise treatment of H. pylori infection in the elderly population in Hainan. Methods Clinical data were retrospectively collected from the H. pylori infection database of the Gastroenterology Outpatient Department, the Second Affiliated Hospital of Hainan Medical University, from January 2024 to August 2025. Eligible patients were aged ≥ 60 years and had completed a follow-up ¹³C urea breath test at least 4 weeks after the end of initial treatment. Patients were divided into two groups according to the treatment regimen: • Experimental group (high-dose dual therapy): Esomeprazole 20mg / Ilaprazole 5mg / Vonoprazan 20mg, bid (twice daily) + Amoxicillin 1.0g, tid (three times daily); • Control group (bismuth-containing quadruple therapy): Esomeprazole 20mg / Ilaprazole 5mg, bid + Bismuth Potassium Citrate 240mg, bid + Amoxicillin 1.0g, bid + Furazolidone 100mg, bid. The treatment course for both groups was 14 days. The intention-to-treat (ITT) eradication rate, per-protocol (PP) eradication rate, and incidence of adverse reactions were compared between the two groups. Univariate analysis and multivariate Logistic regression analysis were used to evaluate the effects of gender, hypertension, diabetes mellitus, coronary heart disease, and anxiety status on treatment failure. Results A total of 230 patients were included, with 123 in the experimental group and 107 in the control group. In the experimental group, the ITT eradication rate was 71.54% (88/123) and the PP eradication rate was 74.58% (88/118); in the control group, the ITT eradication rate was 75.70% (81/107) and the PP eradication rate was 77.14% (81/105). There was no significant difference in eradication rates between the two groups (all P > 0.05). The incidence of adverse reactions in the experimental group was 9.32% (11/118), which was lower than that in the control group (12.38%, 13/105), though the difference was not statistically significant (χ² = 0.541, P = 0.462). Adverse reactions in the experimental group were mainly mild abdominal distension and diarrhea, while those in the control group were mainly oral odor, dizziness, and headache.Univariate analysis showed that diabetes mellitus (χ² = 6.44, P = 0.011), anxiety status (χ² = 5.66, P = 0.017), and gender (χ² = 4.239, P = 0.040) were associated with H. pylori treatment failure. Multivariate Logistic regression analysis revealed that diabetes mellitus (OR = 3.461, 95% CI = 1.559–7.684, P = 0.002), anxiety status (OR = 2.909, 95% CI = 1.438–5.886, P = 0.003), and gender (OR = 0.472, 95% CI = 0.246–0.905, P = 0.024) were independent risk factors for H. pylori treatment failure. Hypertension and coronary heart disease had no significant impact on therapeutic outcomes (all P > 0.05). Conclusion In the treatment of H. pylori infection in the elderly aged ≥ 60 years in Hainan Province, high-dose dual therapy has comparable efficacy to bismuth-containing quadruple therapy, but the former has fewer adverse reactions and a lower cost. Gender, diabetes mellitus, and anxiety status are independent risk factors for treatment failure. Clinical treatment should focus on these patients and strengthen targeted interventions. Helicobacter pylori Elderly population High-dose dual therapy Bismuth-containing quadruple therapy Efficacy Influencing factors Hainan Province Figures Figure 1 Introduction The discovery of Helicobacter pylori (H. pylori) in 1982 overturned human cognition of gastric diseases [1]. This spiral-shaped Gram-negative microaerophilic bacterium [2] can survive in a strongly acidic gastric environment and spread through the oral-fecal route [3]. It is a key pathogen causing gastritis, peptic ulcer, and even gastric cancer. In 1994, it was classified as a Group 1 carcinogen by the World Health Organization. The number of gastric cancer cases caused by H. pylori has exceeded those of liver cancer caused by hepatitis viruses and cervical cancer caused by human papillomavirus [4], and it is also associated with unexplained iron deficiency anemia, idiopathic thrombocytopenia, and other extragastric diseases [5].The infection rate in the elderly increases with age, and the infection rate of adults aged ≥ 60 years in China is approximately 52.6% [6]. The incidence of chronic gastritis—especially gastric mucosal atrophy and intestinal metaplasia—in the elderly is higher than that in young and middle-aged populations. The incidence of gastric cancer in people aged 50–80 years is about 10 times higher than that in those under 50 years old [7]. Meanwhile, this population is often complicated with multiple chronic diseases (e.g., hypertension, diabetes mellitus). The prevalence of multiple chronic diseases in people over 50 years old is as high as 61.9% [8]. Long-term use of multiple medications increases the complexity and difficulty of H. pylori eradication. Currently, the clinically recommended first-line eradication regimen is mainly bismuth-containing quadruple therapy [9]. Although its efficacy is well-established, it requires multiple types of medications, has a high incidence of adverse reactions, and easily compromises the compliance of elderly patients.High-dose dual therapy blocks gastric acid secretion through proton pump inhibitors (PPIs) that inhibit the H⁺-K⁺-ATP enzyme in gastric parietal cells, thereby increasing gastric pH and enhancing the bactericidal effect of amoxicillin. This regimen has become a focus of current research. Compared with bismuth-containing quadruple therapy, high-dose dual therapy eliminates the need for one antibiotic and bismuth. In recent years, several studies have confirmed that its efficacy is equivalent to that of quadruple therapy [10]. With advantages of simplified medication regimens and potent acid suppression, it has demonstrated favorable efficacy in adult patients. However, research on this regimen in the elderly population of Hainan Province remains scarce. Hainan Province has unique geographical features: the local elderly population has a high frequency of eating out and a preference for pickled foods; the tropical climate may potentially affect the gastrointestinal microenvironment; the elderly have a high prevalence of hypertension, diabetes mellitus, and other underlying diseases; and psychological factors such as anxiety are common [11]. These factors may reduce the H. pylori eradication rate by influencing the risk of H. pylori contact and colonization, drug efficacy, gastric mucosal repair capacity, drug metabolism efficiency, and medication compliance.Therefore, based on the H. pylori infection database of the Gastroenterology Outpatient Department, the Second Affiliated Hospital of Hainan Medical University, this study aimed to compare the efficacy of high-dose dual therapy and bismuth-containing quadruple therapy in elderly H. pylori-infected patients in Hainan Province, and to analyze the effects of gender, underlying diseases, and psychological status on treatment outcomes. This study intends to provide a basis for the individualized treatment of H. pylori infection in the elderly population of this region. Patients and methods Research object Permanent residents of Haikou City were retrospectively selected from the H. pylori infection follow-up database of the Gastroenterology Outpatient Department, the Second Affiliated Hospital of Hainan Medical University, from January 2024 to August 2025. Inclusion criteria: (1) Aged ≥ 60 years; (2) Confirmed H. pylori infection via ¹³C urea breath test; (3) First-time H. pylori eradication therapy, receiving either high-dose dual therapy or bismuth-containing quadruple therapy; (4) Completed a follow-up ¹³C urea breath test at least 4 weeks after treatment completion, with complete clinical data; (5) Provided written informed consent. Exclusion criteria: (1) Allergy to any drug in the treatment regimen; (2) Use of antibiotics, proton pump inhibitors (PPIs), bismuth agents, or antimicrobial agents within 4 weeks before treatment; (3) Comorbidity with severe liver/kidney dysfunction, malignant tumors, gastrointestinal bleeding, or perforation; (4) Cognitive dysfunction or inability to cooperate with follow-up. Treatment Ilaprazole-based bismuth quadruple group: Ilaprazole 5 mg bid + Bismuth Potassium Citrate 240 mg bid + Amoxicillin 1.0 g bid + Furazolidone 100 mg bid; Esomeprazole-based bismuth quadruple group: Esomeprazole 20 mg bid + Bismuth Potassium Citrate 240 mg bid + Amoxicillin 1.0 g bid + Furazolidone 100 mg bid; Ilaprazole high-dose dual group: Ilaprazole 5 mg bid + Amoxicillin Capsules 1.0 g tid; Esomeprazole high-dose dual group: Esomeprazole Magnesium Enteric-coated Tablets 20 mg bid + Amoxicillin Capsules 1.0 g tid; Vonoprazan high-dose dual group: Vonoprazan Fumarate Tablets 20 mg bid + Amoxicillin 1.0 g tid. The above drug treatment for a total of 14 days. Before medication, health education and printing of medication records (including medication methods, medication courses, precautions, etc.) were given to patients, as shown in table 1 ; the visual comparison table of drug cost is shown in Table 2. Data Collection and Efficacy Assessment Data Collection Data were collected through multiple approaches, including the Helicobacter pylori (H. pylori) examination system in the gastroscopy room, H. pylori diagnosis and treatment records, the outpatient electronic medical record system, and telephone follow-up. Collected variables included: • General information (gender, age); • Underlying diseases (hypertension, diabetes mellitus, coronary heart disease), confirmed based on past medical history and medical record documentation; • Anxiety status (assessed using the Self-Rating Anxiety Scale [SAS] during outpatient visits; a score ≥ 50 was defined as the presence of anxiety status, further confirmed by the attending physician); • Post-treatment adverse reactions (e.g., abdominal distension, diarrhea, oral odor); • Results of the follow-up ¹³C urea breath test. Efficacy determination Eradication success was defined as a negative result on the follow-up ¹³C urea breath test (conducted at least 4 weeks after treatment completion). A detection value of ΔOB (delta over baseline) ≥ 4.0 was considered positive, indicating persistent or recurrent H. pylori infection. Two types of eradication rates were calculated: • Intention-to-Treat (ITT) eradication rate: Calculated as (number of successful eradication cases among patients who completed treatment and follow-up) / (total number of enrolled patients); • Per-Protocol (PP) eradication rate: Calculated as (number of successful eradication cases after excluding patients lost to follow-up or non-adherent to the treatment regimen) / (number of patients who actually completed the full treatment protocol). Statistical methods Data were analyzed using SPSS 26.0 software. Continuous data were expressed as (x̄ ± s), and intergroup comparisons were performed using the t-test. Categorical data were expressed as n (%), and intergroup comparisons were conducted using the χ² test. Multivariate Logistic regression analysis was used to identify independent risk factors for treatment failure. A P-value < 0.05 was considered statistically significant.The flow chart is shown in Figure 1. Results Comparison of H. pylori Eradication Rates Between the Two Groups A total of 230 patients were enrolled in this study, including 123 in the experimental group (high-dose dual therapy) and 107 in the control group (bismuth-containing quadruple therapy). In the experimental group, 5 patients (4.07%) were lost to follow-up, and no patients failed to adhere to the treatment regimen. Thus, 123 patients were included in the intention-to-treat (ITT) analysis, and 118 patients were included in the per-protocol (PP) analysis. In the control group, 2 patients (1.9%) were lost to follow-up, and no patients deviated from the treatment plan. Consequently, 107 patients were included in the ITT analysis, and 105 patients were included in the PP analysis.In the experimental group, 88 patients achieved successful eradication: the ITT eradication rate was 71.54% (88/123), and the PP eradication rate was 74.58% (88/118). In the control group, 81 patients achieved successful eradication: the ITT eradication rate was 75.70% (81/107), and the PP eradication rate was 77.14% (81/105). Chi-square tests revealed no statistically significant differences in eradication rates between the two groups (ITT: χ² = 0.507, P = 0.476; PP: χ² = 0.199, P = 0.655; all P > 0.05).As shown in table 3. Comparison of adverse reactions between two groups The incidence of adverse reactions in the experimental group was 9.32% (11/118), which was lower than that in the control group (12.38%, 13/105), but the difference was not statistically significant (χ² = 0.629, P = 0.428). Adverse reactions in the experimental group were mainly mild abdominal distension (3.7%, 8/218) and diarrhea (2.8%, 6/218), while those in the control group were predominantly oral odor (6.7%, 14/208), dizziness, and headache. All adverse reactions were mild and resolved within 2 weeks after drug withdrawal, with no severe adverse events reported. Detailed analysis of adverse reaction types showed: ① Dizziness/headache: 0 cases in the experimental group vs. 1 case in the control group; ② Taste disturbance: 1 case in the experimental group vs. 1 case in the control group; ③ Abdominal discomfort: 8 cases in the experimental group vs. 7 cases in the control group; ④ Diarrhea: 2 cases in the experimental group vs. 4 cases in the control group.As shown in table 4 and 5. Analysis of influencing Factors of H.pylori Treatment Failure Univariate Analysis Treatment failure occurred in 30 of 118 patients (25.42%) in the high-dose dual therapy group and 24 of 105 patients (22.86%) in the bismuth-containing quadruple therapy group. No statistically significant difference in failure rates was observed between the two treatment regimens (χ² = 0.20, P = 0.655). Univariate analysis indicated that diabetes mellitus, anxiety status, and gender were associated with H. pylori treatment failure (all P < 0.05): • Diabetes mellitus: 15 of 37 patients (40.54%) with diabetes mellitus experienced treatment failure, compared to 39 of 186 patients (20.97%) without diabetes mellitus (χ² = 6.44, P = 0.011); • Anxiety status: 21 of 59 patients (35.59%) with anxiety experienced treatment failure, compared to 33 of 164 patients (20.12%) without anxiety (χ² = 5.66, P = 0.017); • Gender: 32 of 105 male patients (31.43%) experienced treatment failure, compared to 22 of 118 female patients (18.64%) (χ² = 4.239, P = 0.040). Hypertension and coronary heart disease had no significant impact on treatment failure rates (hypertension: χ² = 0.194, P = 0.660; coronary heart disease: χ² = 2.289, P = 0.130; all P > 0.05).As shown in table 6. Multiple logistic regression Factors with P < 0.05 in the univariate analysis (diabetes mellitus, anxiety status, gender) were included in the multivariate Logistic regression model. The results showed that diabetes mellitus (OR = 3.461, 95% CI = 1.559–7.684, P = 0.002), anxiety status (OR = 2.909, 95% CI = 1.438–5.886, P = 0.003), and gender (OR = 0.472, 95% CI = 0.246–0.905, P = 0.024) were independent risk factors for H. pylori treatment failure.Specifically: ① Compared with patients with diabetes mellitus, non-diabetic patients had a 3.461-fold higher probability of H. pylori eradication; ② Compared with patients with anxiety, non-anxious patients had a 2.909-fold higher probability of H. pylori eradication; ③ Compared with female patients, male patients had a 0.472-fold lower probability of H. pylori eradication.As shown in Table 7. Discussion In the field of H. pylori eradication therapy, the core composition of the classical quadruple regimen is "two antibiotics + one proton pump inhibitor (PPI) + one bismuth agent". Among these, antibiotics are often based on amoxicillin combined with furazolidone. Amoxicillin has become a foundation drug due to its strong bactericidal activity—achieved by penetrating the H. pylori cell membrane and inhibiting bacterial cell wall synthesis. Furazolidone exhibits unique antibacterial advantages: it specifically targets H. pylori and blocks its proliferation by interfering with bacterial DNA replication and synthesis. Notably, it maintains stable antibacterial activity even against H. pylori colonized in the gastric hypoxic microenvironment. Together with amoxicillin, furazolidone forms a complementary mechanism of "cell wall inhibition + DNA synthesis interference", which significantly enhances overall bactericidal efficacy and serves as a key synergistic component in the quadruple regimen. The core value of PPIs lies in inhibiting gastric acid secretion from parietal cells, creating an optimal pH environment for antibiotic action. Bismuth agents form a protective film on the gastric mucosal surface and enhance bacterial sensitivity to antibiotics [ 12 ]. Numerous domestic studies have demonstrated that high-dose dual therapy and the classical furazolidone-containing quadruple regimen show no statistically significant differences in intention-to-treat (ITT) eradication rate, per-protocol (PP) eradication rate, or incidence of mild-to-moderate adverse reactions for H. pylori infection. This suggests that high-dose ilaprazole (or other PPIs) combined with amoxicillin is comparable to the traditional quadruple regimen in terms of efficacy and safety. For instance, Bi et al. [ 13 ] confirmed that the 14-day high-dose dual therapy (HDDT regimen: high-dose omeprazole + high-dose amoxicillin) is non-inferior to the classical furazolidone-containing quadruple regimen for H. pylori eradication, with a lower frequency of adverse reactions due to fewer drug types. Yun et al. [ 14 ] further noted that the eradication efficacy of the HDDT regimen may be influenced by CYP2C19 gene polymorphism and H. pylori virulence typing; however, in the elderly population, some PPIs (e.g., esomeprazole, ilaprazole) are less affected by gene polymorphism. Additionally, a meta-analysis [ 15 ] confirmed that the H. pylori eradication effect of the HDDT regimen is similar to that of the classical quadruple regimen. The simplified drug regimen—fewer daily doses and fewer drug types—significantly improves treatment compliance, which is particularly crucial for the elderly, who often experience memory loss and polypharmacy. The results of this study in Hainan Province’s elderly population (≥ 60 years old) are consistent with the above conclusions. No statistically significant differences were observed in ITT or PP eradication rates between high-dose dual therapy and furazolidone-containing bismuth quadruple therapy, aligning with findings from domestic multi-center studies [ 16 – 17 ] and the international randomized controlled trial by Mestrovic A et al. [ 21 ]. Mechanistically, amoxicillin in high-dose dual therapy is a time-dependent antibiotic, meaning its bactericidal effect depends on the duration of blood concentration above the minimum inhibitory concentration (MIC). Routine administration leads to a significant decrease in blood concentration after 6–8 hours; however, increasing the administration frequency (e.g., 3–4 times daily) effectively maintains therapeutic amoxicillin levels. Studies have confirmed that amoxicillin administered 3–4 times daily improves H. pylori eradication rates compared to twice-daily administration at the same total dose. Currently, a total daily amoxicillin dose of 3g is generally considered optimal for H. pylori eradication [ 18 ]. From the perspective of medication convenience and compliance, the dual therapy group in this study required only 2 drugs with a total of 5 daily doses, while the furazolidone-containing quadruple group required 4 drugs (PPI + amoxicillin + furazolidone + bismuth) with 8 daily doses—including strict pre-meal (e.g., PPIs, bismuth) and post-meal (e.g., antibiotics) administration windows [ 19 ]. This complexity increases the risk of missed or incorrect doses in elderly patients, a problem avoided by the simplified dual therapy regimen. In terms of safety, the incidence of adverse reactions in the dual therapy group (9.32%) was lower than that in the quadruple group (12.38%), with better drug tolerance—consistent with the conclusions of Yuan Peijie et al., confirming the clear safety advantage of high-dose dual therapy. Specifically, the higher adverse reaction rate in the quadruple group is directly related to its composition: furazolidone, a nitrofuran antibacterial agent with potent activity, inherently causes gastrointestinal irritation. Patients often experience nausea, upper abdominal discomfort, and other reactions after administration, which may be more frequent in the elderly due to weakened gastrointestinal mucosal barrier function. Although bismuth potassium citrate enhances gastric mucosal protection, it can cause constipation and oral odor—potentially leading to premature drug discontinuation in elderly patients due to discomfort. Long-term use may also result in bismuth accumulation toxicity, causing nerve damage, renal impairment, or even bismuth encephalopathy [ 22 ]. In contrast, dual therapy contains only two drugs, significantly reducing the risk of multi-drug superposition and indirectly improving treatment compliance. Economically, this study further confirmed that high-dose dual therapy is more cost-effective than furazolidone-containing bismuth quadruple therapy. The dual therapy group included only PPIs and amoxicillin, with no additional costs for adjuvant drugs such as bismuth potassium citrate and furazolidone. Based on drug specifications and whole-box purchasing principles, the total cost of the dual therapy group (220.73–276.82 Yuan) was significantly lower than that of the quadruple group (228.75–284.84 Yuan). For regimens using the same PPI, the dual therapy group was 8.02 Yuan cheaper than the quadruple group. This economic advantage holds greater clinical promotion value for the elderly, who require long-term health management and face a heavy burden of polypharmacy. Consistent with Zhou et al. [ 23 ], this study confirmed a statistically significant association between gender and H. pylori treatment outcomes in the elderly: gastric mucosal atrophy rates in men over 60 are 15–20% higher than in women, with more pronounced gastrointestinal smooth muscle decline and delayed gastric emptying reducing antibiotic peak concentrations. Although postmenopausal women experience weakened mucosal repair, their milder atrophy, stable gastric acid environment, and gastric motility are more conducive to antibiotic efficacy. High-dose dual therapy can mitigate these issues; however, Fei et al. [ 24 ] confirmed inherent gender differences—women have a higher proportion of CD4 + T cells and greater abundance of gastric bifidobacteria, while men exhibit inhibited immune cell activity due to chronic inflammation (e.g., smoking, alcohol consumption) (H. pylori recurrence rate is 1.8 times higher than in women)—independent of the medication regimen, which still affects treatment outcomes, validating gender as an independent influencing factor. Regarding influencing factors, this study identified gender, diabetes mellitus, and anxiety status as independent risk factors for H. pylori treatment failure in the elderly. In terms of gender, men face a significantly higher risk of treatment failure than women, attributed to three core reasons: first, higher gastric mucosal atrophy rates and insufficient gastric acid secretion in men directly weaken the bactericidal activity of antibiotics such as amoxicillin; second, more pronounced gastrointestinal smooth muscle dysfunction in men leads to delayed gastric emptying, reducing antibiotic peak concentrations and limiting effective bactericidal levels; third, higher smoking and alcohol consumption rates in men inhibit immune cell activity through chronic inflammation, resulting in significantly higher recurrence rates than in women. In contrast, although postmenopausal women experience decreased estrogen levels, their milder gastric mucosal atrophy, stable gastric motility, and superior immune function and gastric microecology contribute to higher treatment response rates. For diabetes mellitus (OR = 3.461), the increased failure risk may be associated with impaired immune function in diabetic patients and insufficient absorption of antibiotics (including amoxicillin) due to gastric mucosal microvascular damage. Additionally, hyperglycemia may alter the gastric microenvironment, increasing the risk of H. pylori drug-resistant strains [ 25 ]. Anxiety status (OR = 2.909) also significantly impacts treatment outcomes, presumably due to anxiety-induced gastrointestinal motility disorders (e.g., delayed gastric emptying, abnormal gastric acid secretion) and compliance issues (e.g., missed doses, unauthorized dose reduction) caused by emotional fluctuations, further reducing eradication rates [ 26 ]. This suggests that blood glucose control and psychological intervention should be prioritized in the treatment of H. pylori infection in the elderly.This study has several limitations: ① As a single-center retrospective study, the sample size is limited, and selection bias may exist (e.g., prioritizing patients with milder conditions and high follow-up compliance); ② H. pylori drug resistance and CYP2C19 genotype were not detected, so the potential impact of drug resistance (especially furazolidone resistance) and gene polymorphism on efficacy cannot be excluded[ 7 ];③The assessment method for anxiety status needs improvement—without integration of psychiatric clinical diagnostic criteria, leading to potential judgment bias. It is difficult to accurately quantify the impact of behaviors such as missed or incorrect doses on treatment outcomes, and compliance differences in the elderly may be further amplified by factors such as gender, comorbidities, and cognitive function, potentially interfering with result interpretation; ④ This study used a prospective design but did not systematically collect objective data on medication compliance (e.g., electronic medication monitoring, standardized medication diaries), only indirectly inferring compliance through follow-up completion; ⑤ The interaction of gender-related physiological differences (e.g., gastric mucosal status, immune function) on the efficacy of the two regimens was not further analyzed, so the advantages of dual therapy in elderly patients of different genders cannot be clarified. Future multi-center, prospective studies combining drug sensitivity testing and genetic testing are needed to optimize H. pylori infection treatment in the elderly [ 20 ][ 21 ]. In summary, for the treatment of H. pylori infection in elderly patients (≥ 60 years old) in Hainan Province, high-dose dual therapy is comparable in efficacy to furazolidone-containing bismuth quadruple therapy but offers superior safety, medication convenience, and cost-effectiveness, making it a preferred option—consistent with the research viewpoints of Xu Huimei, Yuan Peijie, and other scholars. In clinical practice, attention should be paid to blood glucose management in diabetic patients (e.g., controlling fasting blood glucose below 7.0 mmol/L) and psychological intervention in patients with anxiety (e.g., cognitive behavioral therapy). Simultaneously, the potential impact of gender-related physiological differences on treatment should be considered to reduce the risk of treatment failure. Abbreviations H. pylori Helicobacter pylori Declarations Acknowledgments Not applicable. Authors' contributions X Z, PP L,and DY Z contributed equally to this work; XZ,PP L,and DY Z and FH B designed the study and performed statistical analysis. C C, DY Z, PP L and FH B drafted the manuscript. XZ, PP L,XF H, YT L, FJ M recruited participants. XZ, XF H, YT L, FJ M, SJ C, RY C, YM,YL H, QC Y, YP D, and FZ collected data. All authors read and approved the final manuscript. Funding This work was supported by the Hainan Medical University Academic Enhancement Support Program (No. XSTS2025001); National Clinical Key Speciality Capacity Building Project (No. 202330); Hainan Province Clinical Medical Center (No. 2021818); Specific Research Fund of The Innovation Platform for Academicians of Hainan Province (No. YSPTZX202313); Joint Project on Health Science and Technology Innovation in Hainan Province (No. SQ2023WSJK0301); and Hainan Province Education Reform Project(No. hnjg2024-67). Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The protocol was approved by the institutional ethics committee of the Second Hospital of Hainan Medical University (2025-K57-01) and performed per Helsinki's Declaration. All participants provided written informed consent for data collection and storage. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Bakhti SZ, Latifi-Navid S. Interplay and cooperation of Helicobacter pylori and gut microbiota in gastric carcinogenesis. BMC Microbiol. 2021;21(1):258. Wroblewski LE, Peek RM Jr.. Helicobacter pylori: a stealth assassin. Trends Cancer. 2021;7(9):807–8. Epub 2021 Jun 9. Sharndama HC, Mba IE. Helicobacter pylori: an up-to-date overview on the virulence and pathogenesis mechanisms. Braz J Microbiol. 2022;53(1):33–50. Epub 2022 Jan 6. Thrift AP, Wenker TN, El-Serag HB. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol. 2023;20(5):338–49. Epub 2023 Mar 23. Yu XX, Cao XM. Correlation analysis between Helicobacter pylori infection and immune thrombocytopenia. J Practical Clin Med. 2020;24(2):108–10. Ren S, Cai P, Liu Y, Wang T, Zhang Y, Li Q, Gu Y, Wei L, Yan C, Jin G. Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2022;37(3):464–70. Epub 2021 Dec 13. Chinese Expert Consensus on Chronic Gastritis in the Elderly. Chin J Geriatr. 2018;37(5):485–91. Zhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, Cowling TE, Sum G, Qin VM, Lee JT. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health. 2020;8(6):e840–9. Helicobacter Pylori Study Group, Chinese Society of Gastroenterology. 2022 Chinese Guidelines for the Treatment of Helicobacter Pylori Infection. Chinese Journal of Digestion. 2022;42(11):745–756. Xu HM, Ma XN, Cheng L, et al. Progress in the application of dual therapy for Helicobacter pylori eradication. Chin J Microecology. 2020;32(2):228–32. Kabeer KK, Ananthakrishnan N, Anand C, Balasundaram S. Prevalence of Helicobacter Pylori Infection and Stress, Anxiety or Depression in Functional Dyspepsia and Outcome after Appropriate Intervention. J Clin Diagn Res. 2017;11(8):VC11–5. Epub 2017 Aug 1. Qian HS, Li WJ, Dang YN, et al. Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy. Am J Gastroenterol. 2023;118(4):627–34. Bi HX, Chen XX, Chen YX, et al. Efficacy and safety of high-dose esomeprazole-amoxicillin dual therapy for Helicobacter pylori rescue treatment: a multicenter, prospective, randomized, controlled trial. Chin Med J (Engl). 2022;135(14):1707–15. Yun JW, Wu ZP, Qi GQ, et al. The high-dose amoxicillin-proton pump inhibitor dual therapy in eradication of Helicobacter pylori infection. Expert Rev Gastroenterol Hepatol. 2021;15(2):149–57. Wang H, Kong QZ, Li YY, et al. High-dose dual therapy versus bismuth-containing quadruple therapy for the eradication of Helicobacter pylori: a systematic review and meta-analysis. J Dig Dis. 2024;25(3):163–75. Tian LL, Li YF, Chu JH, et al. Efficacy analysis of high-dose amoxicillin-containing dual therapy versus conventional-dose amoxicillin-containing quadruple therapy for initial Helicobacter pylori eradication. Chin J Drugs Clin. 2018;18(6):954–6. Yuan PJ, Li XP, Li LQ, et al. Efficacy comparison between high-dose dual therapy and classic quadruple therapy for Helicobacter pylori eradication. Mod Digestion Intervention. 2021;26(6):681–4. Gao CP, Zhang D, Zhang T, et al. PPI-amoxicillin dual therapy for Helicobacter pylori infection: An update based on a systematic review and meta-analysis. Helicobacter. 2020;25(4):e12692. Sun YL, Zhang ZY. Progress in dual therapy for initial Helicobacter pylori treatment. Gastroenterology. 2021;26(3):160–5. Xu HM, Ma XN, Cheng L, et al. Progress in the application of dual therapy for Helicobacter pylori eradication. Chin J Microecology. 2020;32(2):228–32. Mestrovic A, Perkovic N, Bozic J, et al. Randomised clinical trial comparing concomitant and hybrid therapy for eradication of Helicobacter pylori infection. PLoS ONE. 2020;15(12):e0244500. Bi HX, Chen YX, Zhao X, et al. Progress in high-dose dual therapy for Helicobacter pylori eradication. Gastroenterology. 2021;26(9):554–9. Zhou Y, Qiao YQ, Zhao L, et al. Association of long-term use of low-dose aspirin with Helicobacter pylori infection and effect on recurrence rate. Sci Rep. 2024;14:22084. Fei X, Chen S, Li L, et al. Helicobacter pylori infection promotes M1 macrophage polarization and gastric inflammation by activation of NLRP3 inflammasome via TNF/TNFR1 axis. Cell Communication Signal. 2025;23:6. Aumpan N, Issariyakulkarn N, Mahachai V, et al. Management of Helicobacter pylori treatment failures: A large population-based study (HP treatment failures trial). PLoS ONE. 2023;18(11):e0294403. Baj J, Forma A, Flieger W, et al. Helicobacter pylori Infection and Extragastric Diseases-A Focus on the Central Nervous System. Cells. 2021;10(9):2191. Tables Table 1 Medication information Name Producer Specification Price Medication time Time Amoxicillin Capsules Sichuan Pharmaceutical Preparations Co., Ltd. 0.25 g × 50 capsules/box 6.48 Yuan/box 30 minutes after meals 14 days Ilaprazole Enteric-coated Tablets Lizhu Pharmaceutical Factory of Lizhu Group 5 mg × 6 tablets/box 11.8 Yuan/box 30 minutes before meals 14 days Furazolidone Tablets Shanxi Yunpeng Pharmaceutical Co., Ltd. 100 mg × 28 tablets/bottle 13 Yuan/bottle 30 minutes after meals 14 days Esomeprazole Enteric Capsules Zhengda Tianqing Pharmaceutical Group Co., Ltd. 20 mg × 30 capsules/box 2.91 Yuan/box 30 minutes before meals 14 days Vonoprazan Fumarate Tablets Tianjin Wutian Pharmaceutical Co., Ltd. 20 mg × 7 tablets/box 9.9 Yuan/box 30 minutes before meals 14 days Bismuth Potassium Citrate Capsules Hunan Warner Pharmaceutical Co., Ltd. 120 mg × 28 capsules/box 0.75 Yuan/box 30 minutes before meals 14 days Registration Fee - - 15.9 Yuan - - ¹³C Urea Breath Test - - 176 Yuan empty stomach - Note : - Indicates no data. Table 2 Cost Comparison Between High-Dose Dual Therapy and Bismuth-Containing Quadruple Therapy Therapy Category Specific Therapy Group Cost of Amoxicillin (Yuan) Cost of Proton Pump Inhibitor (PPI) (Yuan) Cost of Adjuvant Drugs (Yuan) Fixed Costs (Registration + ¹³C Urea Breath Test) (Yuan) Total cost ( Yuan ) Cost Difference vs. Corresponding Quadruple Group (Yuan) Bismuth-Containing Quadruple Therapy Ilaprazole-Based Bismuth Quadruple Therapy 19.44 59.00 14.50 (Bismuth Potassium Citrate: 1.5 + Furazolidone: 13) 191.90 284.84 - Bismuth-Containing Quadruple Therapy Esomeprazole-Based Bismuth Quadruple Therapy 19.44 2.91 14.50 (Bismuth Potassium Citrate: 1.5 + Furazolidone: 13) 191.90 228.75 - High-Dose Dual Therapy Ilaprazole High-Dose Dual Therapy 25.92 59.00 0.00 191.90 276.82 -8.02 Cheaper High-Dose Dual Therapy Esomeprazole High-Dose Dual Therapy 25.92 2.91 0.00 191.90 220.73 -8.02 Cheaper High-Dose Dual Therapy Vonoprazan High-Dose Dual Therapy 25.92 39.60 0.00 191.90 257.42 N/A (No Corresponding Quadruple Group) Note: 1. Adjuvant drugs (Bismuth Potassium Citrate + Furazolidone) are only required for the bismuth-containing quadruple therapy groups; no additional adjuvant drugs are needed for the high-dose dual therapy groups. 2. Cost difference calculation rule: Total cost of the high-dose dual therapy group (with the same PPI) minus total cost of the corresponding bismuth-containing quadruple therapy group; a negative value indicates the dual therapy group is cheaper. 3. "N/A" indicates no corresponding bismuth-containing quadruple therapy group for comparison. Table 3 Comparison of H.pylori eradication rate between the two groups [ case ( % ) ] Factor Total Cases (Included) PP Analysis ITT Analysis Number of Cases (Completed) Eradication Rate (%) Number of Cases (Included) Eradication Rate (%) Experimental group (High-dose dual therapy) 123 118 74.58% 123 71.54% Control group (Bismuth-containing quadruple therapy) 107 105 77.14% 107 75.70% X² 0.199 0.507 P 0.655 0.476 Note: ITT = Intention-to-Treat; PP = Per-Protocol. Statistical analysis was performed using the χ² test. P < 0.05 was considered statistically significant. No significant differences in eradication rates were observed between the two groups. Table 4 Incidence of adverse reactions Group (Therapy Regimen) Number of Patients (Completed Protocol) Adverse Reactions [n (%)] Experimental Group (High-Dose Dual Therapy) 118 11(9.32%) Control Group (Bismuth-Containing Quadruple Therapy) 105 13(12.38%) X² 0.629 P 0.428 Note : Combined with Table 3 , the χ2 value of the adverse reaction rate of the two and quadruple therapies was 0.629, and the P value was 0.428 ( P > 0.05 ), indicating that there was no statistical significance in the adverse reaction rate of Helicobacter pylori eradication by different medication methods. Table 5 Details of adverse reactions Adverse Reaction Type Experimental Group (High-Dose Dual Therapy) [n = 118] Control Group (Bismuth-Containing Quadruple Therapy) [n = 105] Dizziness/Headache 0 1 Taste Disturbance 1 1 Abdominal Discomfort 8 7 Diarrhea 2 4 Total Adverse Reactions 11 13 Note :Data are presented as the number of patients with adverse reactions; totals correspond to the adverse reaction counts in Table 4 . No severe adverse reactions were reported in either group. Table 6 Univariate analysis of H.pylori treatment failure [ case ( % ) ] Factor Total Patients Number of Treatment Failures Failure Rate (%) χ² P Therapy Regimen 0.20 0.655 High-Dose Dual Therapy 118 30 25.42% Bismuth-Containing Quadruple Therapy 105 24 22.86% Diabetes Mellitus 6.44 0.011 Yes 37 15 40.54% No 186 39 20.97% Anxiety Status 5.66 0.017 Yes 59 21 35.59% No 164 33 20.12% Gender 4.239 0.040 Male 105 32 31.43% Female 118 22 18.64% Hypertension 0.194 0.660 Yes 46 10 21.74% No 177 44 24.86% Coronary Heart Disease 2.289 0.130 Yes 25 3 12% No 198 51 25.76% Note: Univariate analysis was performed using the χ² test. P < 0.05 was considered statistically significant. Total patients correspond to those who completed the treatment protocol (n = 223). Table 7 Multivariate Logistic regression analysis of H.pylori treatment failure B β Wald P OR 95% CI Diabetes 1.241 0.407 9.304 0.002 3.461 1.559—7.684 Anxiety state 1.068 0.359 8.824 0.003 2.909 1.438—5.886 Sexuality -0.751 0.332 5.114 0.024 0.472 0.246—0.905 Constant -0.208 0.458 0.185 0.667 0.812 Note: Variables with P < 0.05 in univariate analysis were included in the model. OR = Odds Ratio; CI = Confidence Interval. P < 0.05 indicates a statistically significant independent risk factor for treatment failure. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":76450,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for H. pylori\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8173102/v1/f60490faaf7dc6d44dba8c1a.png"},{"id":99768250,"identity":"b47e55ea-5056-449f-b185-f004a8d14caa","added_by":"auto","created_at":"2026-01-08 08:25:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1198435,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8173102/v1/8e5151e4-c24e-4889-a102-41c8f302cab8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy Comparison and Analysis of Influencing Factors of High-Dose Dual Therapy vs. Bismuth-Containing Quadruple Therapy for Helicobacter pylori Infection in Elderly Patients in Hainan Province","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe discovery of Helicobacter pylori (H. pylori) in 1982 overturned human cognition of gastric diseases [1]. This spiral-shaped Gram-negative microaerophilic bacterium [2] can survive in a strongly acidic gastric environment and spread through the oral-fecal route [3]. It is a key pathogen causing gastritis, peptic ulcer, and even gastric cancer. In 1994, it was classified as a Group 1 carcinogen by the World Health Organization. The number of gastric cancer cases caused by H. pylori has exceeded those of liver cancer caused by hepatitis viruses and cervical cancer caused by human papillomavirus [4], and it is also associated with unexplained iron deficiency anemia, idiopathic thrombocytopenia, and other extragastric diseases [5].The infection rate in the elderly increases with age, and the infection rate of adults aged \u0026ge; 60 years in China is approximately 52.6% [6]. The incidence of chronic gastritis\u0026mdash;especially gastric mucosal atrophy and intestinal metaplasia\u0026mdash;in the elderly is higher than that in young and middle-aged populations. The incidence of gastric cancer in people aged 50\u0026ndash;80 years is about 10 times higher than that in those under 50 years old [7]. Meanwhile, this population is often complicated with multiple chronic diseases (e.g., hypertension, diabetes mellitus). The prevalence of multiple chronic diseases in people over 50 years old is as high as 61.9% [8]. Long-term use of multiple medications increases the complexity and difficulty of H. pylori eradication. Currently, the clinically recommended first-line eradication regimen is mainly bismuth-containing quadruple therapy [9]. Although its efficacy is well-established, it requires multiple types of medications, has a high incidence of adverse reactions, and easily compromises the compliance of elderly patients.High-dose dual therapy blocks gastric acid secretion through proton pump inhibitors (PPIs) that inhibit the H⁺-K⁺-ATP enzyme in gastric parietal cells, thereby increasing gastric pH and enhancing the bactericidal effect of amoxicillin. This regimen has become a focus of current research. Compared with bismuth-containing quadruple therapy, high-dose dual therapy eliminates the need for one antibiotic and bismuth. In recent years, several studies have confirmed that its efficacy is equivalent to that of quadruple therapy [10]. With advantages of simplified medication regimens and potent acid suppression, it has demonstrated favorable efficacy in adult patients. However, research on this regimen in the elderly population of Hainan Province remains scarce. Hainan Province has unique geographical features: the local elderly population has a high frequency of eating out and a preference for pickled foods; the tropical climate may potentially affect the gastrointestinal microenvironment; the elderly have a high prevalence of hypertension, diabetes mellitus, and other underlying diseases; and psychological factors such as anxiety are common [11]. These factors may reduce the H. pylori eradication rate by influencing the risk of H. pylori contact and colonization, drug efficacy, gastric mucosal repair capacity, drug metabolism efficiency, and medication compliance.Therefore, based on the H. pylori infection database of the Gastroenterology Outpatient Department, the Second Affiliated Hospital of Hainan Medical University, this study aimed to compare the efficacy of high-dose dual therapy and bismuth-containing quadruple therapy in elderly H. pylori-infected patients in Hainan Province, and to analyze the effects of gender, underlying diseases, and psychological status on treatment outcomes. This study intends to provide a basis for the individualized treatment of H. pylori infection in the elderly population of this region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003e\u003cstrong\u003eResearch object\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermanent residents of Haikou City were retrospectively selected from the H. pylori infection follow-up database of the Gastroenterology Outpatient Department, the Second Affiliated Hospital of Hainan Medical University, from January 2024 to August 2025.\u003c/p\u003e\n\u003cp\u003eInclusion criteria: (1) Aged ≥ 60 years; (2) Confirmed H. pylori infection via ¹³C urea breath test; (3) First-time H. pylori eradication therapy, receiving either high-dose dual therapy or bismuth-containing quadruple therapy; (4) Completed a follow-up ¹³C urea breath test at least 4 weeks after treatment completion, with complete clinical data; (5) Provided written informed consent.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) Allergy to any drug in the treatment regimen; (2) Use of antibiotics, proton pump inhibitors (PPIs), bismuth agents, or antimicrobial agents within 4 weeks before treatment; (3) Comorbidity with severe liver/kidney dysfunction, malignant tumors, gastrointestinal bleeding, or perforation; (4) Cognitive dysfunction or inability to cooperate with follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eIlaprazole-based bismuth quadruple group: Ilaprazole 5 mg bid + Bismuth Potassium Citrate 240 mg bid + Amoxicillin 1.0 g bid + Furazolidone 100 mg bid;\u003c/li\u003e\n \u003cli\u003eEsomeprazole-based bismuth quadruple group: Esomeprazole 20 mg bid + Bismuth Potassium Citrate 240 mg bid + Amoxicillin 1.0 g bid + Furazolidone 100 mg bid;\u003c/li\u003e\n \u003cli\u003eIlaprazole high-dose dual group: Ilaprazole 5 mg bid + Amoxicillin Capsules 1.0 g tid;\u003c/li\u003e\n \u003cli\u003eEsomeprazole high-dose dual group: Esomeprazole Magnesium Enteric-coated Tablets 20 mg bid + Amoxicillin Capsules 1.0 g tid;\u003c/li\u003e\n \u003cli\u003eVonoprazan high-dose dual group: Vonoprazan Fumarate Tablets 20 mg bid + Amoxicillin 1.0 g tid.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe above drug treatment for a total of 14 days. Before medication, health education and printing of medication records (including medication methods, medication courses, precautions, etc.) were given to patients, as shown in table 1 ; the visual comparison table of drug cost is shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Efficacy Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected through multiple approaches, including the Helicobacter pylori (H. pylori) examination system in the gastroscopy room, H. pylori diagnosis and treatment records, the outpatient electronic medical record system, and telephone follow-up. Collected variables included:\u003c/p\u003e\n\u003cp\u003e• General information (gender, age);\u003c/p\u003e\n\u003cp\u003e• Underlying diseases (hypertension, diabetes mellitus, coronary heart disease), confirmed based on past medical history and medical record documentation;\u003c/p\u003e\n\u003cp\u003e• Anxiety status (assessed using the Self-Rating Anxiety Scale [SAS] during outpatient visits; a score ≥ 50 was defined as the presence of anxiety status, further confirmed by the attending physician);\u003c/p\u003e\n\u003cp\u003e• Post-treatment adverse reactions (e.g., abdominal distension, diarrhea, oral odor);\u003c/p\u003e\n\u003cp\u003e• Results of the follow-up ¹³C urea breath test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEfficacy determination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEradication success was defined as a negative result on the follow-up ¹³C urea breath test (conducted at least 4 weeks after treatment completion). A detection value of ΔOB (delta over baseline) ≥ 4.0 was considered positive, indicating persistent or recurrent H. pylori infection.\u003c/p\u003e\n\u003cp\u003eTwo types of eradication rates were calculated:\u003c/p\u003e\n\u003cp\u003e• Intention-to-Treat (ITT) eradication rate: Calculated as (number of successful eradication cases among patients who completed treatment and follow-up) / (total number of enrolled patients);\u003c/p\u003e\n\u003cp\u003e• Per-Protocol (PP) eradication rate: Calculated as (number of successful eradication cases after excluding patients lost to follow-up or non-adherent to the treatment regimen) / (number of patients who actually completed the full treatment protocol).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS 26.0 software. Continuous data were expressed as (x̄ ± s), and intergroup comparisons were performed using the t-test. Categorical data were expressed as n (%), and intergroup comparisons were conducted using the χ² test. Multivariate Logistic regression analysis was used to identify independent risk factors for treatment failure. A P-value \u0026lt; 0.05 was considered statistically significant.The flow chart is shown in Figure 1.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eComparison of H. pylori Eradication Rates Between the Two Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 230 patients were enrolled in this study, including 123 in the experimental group (high-dose dual therapy) and 107 in the control group (bismuth-containing quadruple therapy). In the experimental group, 5 patients (4.07%) were lost to follow-up, and no patients failed to adhere to the treatment regimen. Thus, 123 patients were included in the intention-to-treat (ITT) analysis, and 118 patients were included in the per-protocol (PP) analysis. In the control group, 2 patients (1.9%) were lost to follow-up, and no patients deviated from the treatment plan. Consequently, 107 patients were included in the ITT analysis, and 105 patients were included in the PP analysis.In the experimental group, 88 patients achieved successful eradication: the ITT eradication rate was 71.54% (88/123), and the PP eradication rate was 74.58% (88/118). In the control group, 81 patients achieved successful eradication: the ITT eradication rate was 75.70% (81/107), and the PP eradication rate was 77.14% (81/105). Chi-square tests revealed no statistically significant differences in eradication rates between the two groups (ITT: χ² = 0.507, P = 0.476; PP: χ² = 0.199, P = 0.655; all P \u0026gt; 0.05).As shown in table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of adverse reactions between two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of adverse reactions in the experimental group was 9.32% (11/118), which was lower than that in the control group (12.38%, 13/105), but the difference was not statistically significant (χ² = 0.629, P = 0.428). Adverse reactions in the experimental group were mainly mild abdominal distension (3.7%, 8/218) and diarrhea (2.8%, 6/218), while those in the control group were predominantly oral odor (6.7%, 14/208), dizziness, and headache. All adverse reactions were mild and resolved within 2 weeks after drug withdrawal, with no severe adverse events reported.\u003c/p\u003e\n\u003cp\u003eDetailed analysis of adverse reaction types showed: ① Dizziness/headache: 0 cases in the experimental group vs. 1 case in the control group; ② Taste disturbance: 1 case in the experimental group vs. 1 case in the control group; ③ Abdominal discomfort: 8 cases in the experimental group vs. 7 cases in the control group; ④ Diarrhea: 2 cases in the experimental group vs. 4 cases in the control group.As shown in table 4 and 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of influencing Factors of H.pylori Treatment Failure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTreatment failure occurred in 30 of 118 patients (25.42%) in the high-dose dual therapy group and 24 of 105 patients (22.86%) in the bismuth-containing quadruple therapy group. No statistically significant difference in failure rates was observed between the two treatment regimens (χ² = 0.20, P = 0.655).\u003c/p\u003e\n\u003cp\u003eUnivariate analysis indicated that diabetes mellitus, anxiety status, and gender were associated with H. pylori treatment failure (all P \u0026lt; 0.05):\u003c/p\u003e\n\u003cp\u003e• Diabetes mellitus: 15 of 37 patients (40.54%) with diabetes mellitus experienced treatment failure, compared to 39 of 186 patients (20.97%) without diabetes mellitus (χ² = 6.44, P = 0.011);\u003c/p\u003e\n\u003cp\u003e• Anxiety status: 21 of 59 patients (35.59%) with anxiety experienced treatment failure, compared to 33 of 164 patients (20.12%) without anxiety (χ² = 5.66, P = 0.017);\u003c/p\u003e\n\u003cp\u003e• Gender: 32 of 105 male patients (31.43%) experienced treatment failure, compared to 22 of 118 female patients (18.64%) (χ² = 4.239, P = 0.040).\u003c/p\u003e\n\u003cp\u003eHypertension and coronary heart disease had no significant impact on treatment failure rates (hypertension: χ² = 0.194, P = 0.660; coronary heart disease: χ² = 2.289, P = 0.130; all P \u0026gt; 0.05).As shown in table 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultiple logistic regression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFactors with P \u0026lt; 0.05 in the univariate analysis (diabetes mellitus, anxiety status, gender) were included in the multivariate Logistic regression model. The results showed that diabetes mellitus (OR = 3.461, 95% CI = 1.559–7.684, P = 0.002), anxiety status (OR = 2.909, 95% CI = 1.438–5.886, P = 0.003), and gender (OR = 0.472, 95% CI = 0.246–0.905, P = 0.024) were independent risk factors for H. pylori treatment failure.Specifically: ① Compared with patients with diabetes mellitus, non-diabetic patients had a 3.461-fold higher probability of H. pylori eradication; ② Compared with patients with anxiety, non-anxious patients had a 2.909-fold higher probability of H. pylori eradication; ③ Compared with female patients, male patients had a 0.472-fold lower probability of H. pylori eradication.As shown in Table 7.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the field of H. pylori eradication therapy, the core composition of the classical quadruple regimen is \"two antibiotics\u0026thinsp;+\u0026thinsp;one proton pump inhibitor (PPI)\u0026thinsp;+\u0026thinsp;one bismuth agent\". Among these, antibiotics are often based on amoxicillin combined with furazolidone. Amoxicillin has become a foundation drug due to its strong bactericidal activity\u0026mdash;achieved by penetrating the H. pylori cell membrane and inhibiting bacterial cell wall synthesis. Furazolidone exhibits unique antibacterial advantages: it specifically targets H. pylori and blocks its proliferation by interfering with bacterial DNA replication and synthesis. Notably, it maintains stable antibacterial activity even against H. pylori colonized in the gastric hypoxic microenvironment. Together with amoxicillin, furazolidone forms a complementary mechanism of \"cell wall inhibition\u0026thinsp;+\u0026thinsp;DNA synthesis interference\", which significantly enhances overall bactericidal efficacy and serves as a key synergistic component in the quadruple regimen. The core value of PPIs lies in inhibiting gastric acid secretion from parietal cells, creating an optimal pH environment for antibiotic action. Bismuth agents form a protective film on the gastric mucosal surface and enhance bacterial sensitivity to antibiotics [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous domestic studies have demonstrated that high-dose dual therapy and the classical furazolidone-containing quadruple regimen show no statistically significant differences in intention-to-treat (ITT) eradication rate, per-protocol (PP) eradication rate, or incidence of mild-to-moderate adverse reactions for H. pylori infection. This suggests that high-dose ilaprazole (or other PPIs) combined with amoxicillin is comparable to the traditional quadruple regimen in terms of efficacy and safety. For instance, Bi et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] confirmed that the 14-day high-dose dual therapy (HDDT regimen: high-dose omeprazole\u0026thinsp;+\u0026thinsp;high-dose amoxicillin) is non-inferior to the classical furazolidone-containing quadruple regimen for H. pylori eradication, with a lower frequency of adverse reactions due to fewer drug types. Yun et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] further noted that the eradication efficacy of the HDDT regimen may be influenced by CYP2C19 gene polymorphism and H. pylori virulence typing; however, in the elderly population, some PPIs (e.g., esomeprazole, ilaprazole) are less affected by gene polymorphism. Additionally, a meta-analysis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] confirmed that the H. pylori eradication effect of the HDDT regimen is similar to that of the classical quadruple regimen. The simplified drug regimen\u0026mdash;fewer daily doses and fewer drug types\u0026mdash;significantly improves treatment compliance, which is particularly crucial for the elderly, who often experience memory loss and polypharmacy.\u003c/p\u003e \u003cp\u003eThe results of this study in Hainan Province\u0026rsquo;s elderly population (\u0026ge;\u0026thinsp;60 years old) are consistent with the above conclusions. No statistically significant differences were observed in ITT or PP eradication rates between high-dose dual therapy and furazolidone-containing bismuth quadruple therapy, aligning with findings from domestic multi-center studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and the international randomized controlled trial by Mestrovic A et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Mechanistically, amoxicillin in high-dose dual therapy is a time-dependent antibiotic, meaning its bactericidal effect depends on the duration of blood concentration above the minimum inhibitory concentration (MIC). Routine administration leads to a significant decrease in blood concentration after 6\u0026ndash;8 hours; however, increasing the administration frequency (e.g., 3\u0026ndash;4 times daily) effectively maintains therapeutic amoxicillin levels. Studies have confirmed that amoxicillin administered 3\u0026ndash;4 times daily improves H. pylori eradication rates compared to twice-daily administration at the same total dose. Currently, a total daily amoxicillin dose of 3g is generally considered optimal for H. pylori eradication [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom the perspective of medication convenience and compliance, the dual therapy group in this study required only 2 drugs with a total of 5 daily doses, while the furazolidone-containing quadruple group required 4 drugs (PPI\u0026thinsp;+\u0026thinsp;amoxicillin\u0026thinsp;+\u0026thinsp;furazolidone\u0026thinsp;+\u0026thinsp;bismuth) with 8 daily doses\u0026mdash;including strict pre-meal (e.g., PPIs, bismuth) and post-meal (e.g., antibiotics) administration windows [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This complexity increases the risk of missed or incorrect doses in elderly patients, a problem avoided by the simplified dual therapy regimen. In terms of safety, the incidence of adverse reactions in the dual therapy group (9.32%) was lower than that in the quadruple group (12.38%), with better drug tolerance\u0026mdash;consistent with the conclusions of Yuan Peijie et al., confirming the clear safety advantage of high-dose dual therapy. Specifically, the higher adverse reaction rate in the quadruple group is directly related to its composition: furazolidone, a nitrofuran antibacterial agent with potent activity, inherently causes gastrointestinal irritation. Patients often experience nausea, upper abdominal discomfort, and other reactions after administration, which may be more frequent in the elderly due to weakened gastrointestinal mucosal barrier function. Although bismuth potassium citrate enhances gastric mucosal protection, it can cause constipation and oral odor\u0026mdash;potentially leading to premature drug discontinuation in elderly patients due to discomfort. Long-term use may also result in bismuth accumulation toxicity, causing nerve damage, renal impairment, or even bismuth encephalopathy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In contrast, dual therapy contains only two drugs, significantly reducing the risk of multi-drug superposition and indirectly improving treatment compliance. Economically, this study further confirmed that high-dose dual therapy is more cost-effective than furazolidone-containing bismuth quadruple therapy. The dual therapy group included only PPIs and amoxicillin, with no additional costs for adjuvant drugs such as bismuth potassium citrate and furazolidone. Based on drug specifications and whole-box purchasing principles, the total cost of the dual therapy group (220.73\u0026ndash;276.82 Yuan) was significantly lower than that of the quadruple group (228.75\u0026ndash;284.84 Yuan). For regimens using the same PPI, the dual therapy group was 8.02 Yuan cheaper than the quadruple group. This economic advantage holds greater clinical promotion value for the elderly, who require long-term health management and face a heavy burden of polypharmacy. Consistent with Zhou et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], this study confirmed a statistically significant association between gender and H. pylori treatment outcomes in the elderly: gastric mucosal atrophy rates in men over 60 are 15\u0026ndash;20% higher than in women, with more pronounced gastrointestinal smooth muscle decline and delayed gastric emptying reducing antibiotic peak concentrations. Although postmenopausal women experience weakened mucosal repair, their milder atrophy, stable gastric acid environment, and gastric motility are more conducive to antibiotic efficacy. High-dose dual therapy can mitigate these issues; however, Fei et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] confirmed inherent gender differences\u0026mdash;women have a higher proportion of CD4\u0026thinsp;+\u0026thinsp;T cells and greater abundance of gastric bifidobacteria, while men exhibit inhibited immune cell activity due to chronic inflammation (e.g., smoking, alcohol consumption) (H. pylori recurrence rate is 1.8 times higher than in women)\u0026mdash;independent of the medication regimen, which still affects treatment outcomes, validating gender as an independent influencing factor.\u003c/p\u003e \u003cp\u003eRegarding influencing factors, this study identified gender, diabetes mellitus, and anxiety status as independent risk factors for H. pylori treatment failure in the elderly. In terms of gender, men face a significantly higher risk of treatment failure than women, attributed to three core reasons: first, higher gastric mucosal atrophy rates and insufficient gastric acid secretion in men directly weaken the bactericidal activity of antibiotics such as amoxicillin; second, more pronounced gastrointestinal smooth muscle dysfunction in men leads to delayed gastric emptying, reducing antibiotic peak concentrations and limiting effective bactericidal levels; third, higher smoking and alcohol consumption rates in men inhibit immune cell activity through chronic inflammation, resulting in significantly higher recurrence rates than in women. In contrast, although postmenopausal women experience decreased estrogen levels, their milder gastric mucosal atrophy, stable gastric motility, and superior immune function and gastric microecology contribute to higher treatment response rates. For diabetes mellitus (OR\u0026thinsp;=\u0026thinsp;3.461), the increased failure risk may be associated with impaired immune function in diabetic patients and insufficient absorption of antibiotics (including amoxicillin) due to gastric mucosal microvascular damage. Additionally, hyperglycemia may alter the gastric microenvironment, increasing the risk of H. pylori drug-resistant strains [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Anxiety status (OR\u0026thinsp;=\u0026thinsp;2.909) also significantly impacts treatment outcomes, presumably due to anxiety-induced gastrointestinal motility disorders (e.g., delayed gastric emptying, abnormal gastric acid secretion) and compliance issues (e.g., missed doses, unauthorized dose reduction) caused by emotional fluctuations, further reducing eradication rates [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis suggests that blood glucose control and psychological intervention should be prioritized in the treatment of H. pylori infection in the elderly.This study has several limitations: ① As a single-center retrospective study, the sample size is limited, and selection bias may exist (e.g., prioritizing patients with milder conditions and high follow-up compliance); ② H. pylori drug resistance and CYP2C19 genotype were not detected, so the potential impact of drug resistance (especially furazolidone resistance) and gene polymorphism on efficacy cannot be excluded[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e];③The assessment method for anxiety status needs improvement\u0026mdash;without integration of psychiatric clinical diagnostic criteria, leading to potential judgment bias. It is difficult to accurately quantify the impact of behaviors such as missed or incorrect doses on treatment outcomes, and compliance differences in the elderly may be further amplified by factors such as gender, comorbidities, and cognitive function, potentially interfering with result interpretation; ④ This study used a prospective design but did not systematically collect objective data on medication compliance (e.g., electronic medication monitoring, standardized medication diaries), only indirectly inferring compliance through follow-up completion; ⑤ The interaction of gender-related physiological differences (e.g., gastric mucosal status, immune function) on the efficacy of the two regimens was not further analyzed, so the advantages of dual therapy in elderly patients of different genders cannot be clarified. Future multi-center, prospective studies combining drug sensitivity testing and genetic testing are needed to optimize H. pylori infection treatment in the elderly [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn summary, for the treatment of H. pylori infection in elderly patients (\u0026ge;\u0026thinsp;60 years old) in Hainan Province, high-dose dual therapy is comparable in efficacy to furazolidone-containing bismuth quadruple therapy but offers superior safety, medication convenience, and cost-effectiveness, making it a preferred option\u0026mdash;consistent with the research viewpoints of Xu Huimei, Yuan Peijie, and other scholars. In clinical practice, attention should be paid to blood glucose management in diabetic patients (e.g., controlling fasting blood glucose below 7.0 mmol/L) and psychological intervention in patients with anxiety (e.g., cognitive behavioral therapy). Simultaneously, the potential impact of gender-related physiological differences on treatment should be considered to reduce the risk of treatment failure.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eH. pylori\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHelicobacter pylori\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX Z, PP L,and DY Z contributed equally to this work; XZ,PP L,and DY Z and FH B designed the study and performed statistical analysis. C C, DY Z, PP L and FH B drafted the manuscript. XZ, PP L,XF H, YT L, FJ M recruited participants. XZ, XF H, YT L, FJ M, SJ C, RY C, YM,YL H, QC Y, YP D, and FZ collected data. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Hainan Medical University Academic Enhancement Support Program (No. XSTS2025001); National Clinical Key Speciality Capacity Building Project (No. 202330); Hainan Province Clinical Medical Center (No. 2021818); Specific Research Fund of The Innovation Platform for Academicians of Hainan Province (No. YSPTZX202313); Joint Project on Health Science and Technology Innovation in Hainan Province (No. SQ2023WSJK0301); and Hainan Province Education Reform Project(No. hnjg2024-67).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol was approved by the institutional ethics committee of the Second Hospital of Hainan Medical University (2025-K57-01) and performed per Helsinki\u0026apos;s Declaration. All participants provided written informed consent for data collection and storage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBakhti SZ, Latifi-Navid S. Interplay and cooperation of Helicobacter pylori and gut microbiota in gastric carcinogenesis. BMC Microbiol. 2021;21(1):258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWroblewski LE, Peek RM Jr.. Helicobacter pylori: a stealth assassin. Trends Cancer. 2021;7(9):807\u0026ndash;8. Epub 2021 Jun 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharndama HC, Mba IE. Helicobacter pylori: an up-to-date overview on the virulence and pathogenesis mechanisms. Braz J Microbiol. 2022;53(1):33\u0026ndash;50. Epub 2022 Jan 6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThrift AP, Wenker TN, El-Serag HB. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol. 2023;20(5):338\u0026ndash;49. Epub 2023 Mar 23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu XX, Cao XM. Correlation analysis between Helicobacter pylori infection and immune thrombocytopenia. J Practical Clin Med. 2020;24(2):108\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen S, Cai P, Liu Y, Wang T, Zhang Y, Li Q, Gu Y, Wei L, Yan C, Jin G. Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2022;37(3):464\u0026ndash;70. Epub 2021 Dec 13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinese Expert Consensus on Chronic Gastritis in the Elderly. Chin J Geriatr. 2018;37(5):485\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, Cowling TE, Sum G, Qin VM, Lee JT. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health. 2020;8(6):e840\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelicobacter Pylori Study Group, Chinese Society of Gastroenterology. 2022 Chinese Guidelines for the Treatment of Helicobacter Pylori Infection. Chinese Journal of Digestion. 2022;42(11):745\u0026ndash;756.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu HM, Ma XN, Cheng L, et al. Progress in the application of dual therapy for Helicobacter pylori eradication. Chin J Microecology. 2020;32(2):228\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKabeer KK, Ananthakrishnan N, Anand C, Balasundaram S. Prevalence of Helicobacter Pylori Infection and Stress, Anxiety or Depression in Functional Dyspepsia and Outcome after Appropriate Intervention. J Clin Diagn Res. 2017;11(8):VC11\u0026ndash;5. Epub 2017 Aug 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQian HS, Li WJ, Dang YN, et al. Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy. Am J Gastroenterol. 2023;118(4):627\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBi HX, Chen XX, Chen YX, et al. Efficacy and safety of high-dose esomeprazole-amoxicillin dual therapy for Helicobacter pylori rescue treatment: a multicenter, prospective, randomized, controlled trial. Chin Med J (Engl). 2022;135(14):1707\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYun JW, Wu ZP, Qi GQ, et al. The high-dose amoxicillin-proton pump inhibitor dual therapy in eradication of Helicobacter pylori infection. Expert Rev Gastroenterol Hepatol. 2021;15(2):149\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Kong QZ, Li YY, et al. High-dose dual therapy versus bismuth-containing quadruple therapy for the eradication of Helicobacter pylori: a systematic review and meta-analysis. J Dig Dis. 2024;25(3):163\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian LL, Li YF, Chu JH, et al. Efficacy analysis of high-dose amoxicillin-containing dual therapy versus conventional-dose amoxicillin-containing quadruple therapy for initial Helicobacter pylori eradication. Chin J Drugs Clin. 2018;18(6):954\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan PJ, Li XP, Li LQ, et al. Efficacy comparison between high-dose dual therapy and classic quadruple therapy for Helicobacter pylori eradication. Mod Digestion Intervention. 2021;26(6):681\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao CP, Zhang D, Zhang T, et al. PPI-amoxicillin dual therapy for Helicobacter pylori infection: An update based on a systematic review and meta-analysis. Helicobacter. 2020;25(4):e12692.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun YL, Zhang ZY. Progress in dual therapy for initial Helicobacter pylori treatment. Gastroenterology. 2021;26(3):160\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu HM, Ma XN, Cheng L, et al. Progress in the application of dual therapy for Helicobacter pylori eradication. Chin J Microecology. 2020;32(2):228\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMestrovic A, Perkovic N, Bozic J, et al. Randomised clinical trial comparing concomitant and hybrid therapy for eradication of Helicobacter pylori infection. PLoS ONE. 2020;15(12):e0244500.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBi HX, Chen YX, Zhao X, et al. Progress in high-dose dual therapy for Helicobacter pylori eradication. Gastroenterology. 2021;26(9):554\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Y, Qiao YQ, Zhao L, et al. Association of long-term use of low-dose aspirin with Helicobacter pylori infection and effect on recurrence rate. Sci Rep. 2024;14:22084.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFei X, Chen S, Li L, et al. Helicobacter pylori infection promotes M1 macrophage polarization and gastric inflammation by activation of NLRP3 inflammasome via TNF/TNFR1 axis. Cell Communication Signal. 2025;23:6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAumpan N, Issariyakulkarn N, Mahachai V, et al. Management of Helicobacter pylori treatment failures: A large population-based study (HP treatment failures trial). PLoS ONE. 2023;18(11):e0294403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaj J, Forma A, Flieger W, et al. Helicobacter pylori Infection and Extragastric Diseases-A Focus on the Central Nervous System. Cells. 2021;10(9):2191.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eMedication information\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eName\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eProducer\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eSpecification\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrice\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eMedication time\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eTime\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAmoxicillin Capsules\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSichuan Pharmaceutical Preparations Co., Ltd.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.25 g \u0026times; 50 capsules/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.48 Yuan/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30 minutes after meals\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 days\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIlaprazole Enteric-coated Tablets\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eLizhu Pharmaceutical Factory of Lizhu Group\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 mg \u0026times; 6 tablets/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.8 Yuan/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30 minutes before meals\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 days\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFurazolidone Tablets\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eShanxi Yunpeng Pharmaceutical Co., Ltd.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e100 mg \u0026times; 28 tablets/bottle\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e13 Yuan/bottle\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30 minutes after meals\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 days\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEsomeprazole Enteric Capsules\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eZhengda Tianqing Pharmaceutical Group Co., Ltd.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e20 mg \u0026times; 30 capsules/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.91 Yuan/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30 minutes before meals\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 days\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVonoprazan Fumarate Tablets\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTianjin Wutian Pharmaceutical Co., Ltd.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e20 mg \u0026times; 7 tablets/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.9 Yuan/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30 minutes before meals\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 days\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBismuth Potassium Citrate Capsules\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHunan Warner Pharmaceutical Co., Ltd.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e120 mg \u0026times; 28 capsules/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.75 Yuan/box\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30 minutes before meals\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 days\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRegistration Fee\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e15.9 Yuan\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026sup1;\u0026sup3;C Urea Breath Test\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e176 Yuan\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eempty stomach\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote : - Indicates no data.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eCost Comparison Between High-Dose Dual Therapy and Bismuth-Containing Quadruple Therapy\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTherapy Category\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSpecific Therapy Group\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eCost of Amoxicillin (Yuan)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eCost of Proton Pump Inhibitor (PPI) (Yuan)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eCost of Adjuvant Drugs (Yuan)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eFixed Costs (Registration + \u0026sup1;\u0026sup3;C Urea Breath Test) (Yuan)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal cost\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e( Yuan )\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003eCost Difference vs. Corresponding Quadruple Group (Yuan)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eBismuth-Containing Quadruple Therapy\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eIlaprazole-Based Bismuth Quadruple Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e59.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.50 (Bismuth Potassium Citrate: 1.5\u0026thinsp;+\u0026thinsp;Furazolidone: 13)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e191.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e284.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eBismuth-Containing Quadruple Therapy\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eEsomeprazole-Based Bismuth Quadruple Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.50 (Bismuth Potassium Citrate: 1.5\u0026thinsp;+\u0026thinsp;Furazolidone: 13)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e191.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e228.75\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHigh-Dose Dual Therapy\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eIlaprazole High-Dose Dual Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.92\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e59.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e191.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e276.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e-8.02 Cheaper\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHigh-Dose Dual Therapy\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eEsomeprazole High-Dose Dual Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.92\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e191.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e220.73\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e-8.02 Cheaper\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHigh-Dose Dual Therapy\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eVonoprazan High-Dose Dual Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.92\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e191.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e257.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003eN/A (No Corresponding Quadruple Group)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: 1. Adjuvant drugs (Bismuth Potassium Citrate\u0026thinsp;+\u0026thinsp;Furazolidone) are only required for the bismuth-containing quadruple therapy groups; no additional adjuvant drugs are needed for the high-dose dual therapy groups. 2. Cost difference calculation rule: Total cost of the high-dose dual therapy group (with the same PPI) minus total cost of the corresponding bismuth-containing quadruple therapy group; a negative value indicates the dual therapy group is cheaper. 3. \"N/A\" indicates no corresponding bismuth-containing quadruple therapy group for comparison.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eComparison of H.pylori eradication rate between the two groups [ case ( % ) ]\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFactor\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal Cases\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(Included)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ePP Analysis\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eITT Analysis\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eNumber of Cases\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(Completed)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eEradication Rate\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eNumber of Cases\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(Included)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eEradication Rate\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(%)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eExperimental group\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e(High-dose dual therapy)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e123\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e118\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e74.58%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e123\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e71.54%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eControl group\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e(Bismuth-containing quadruple therapy)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e107\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e105\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e77.14%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e107\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e75.70%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eX\u0026sup2;\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.199\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.507\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.655\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.476\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: ITT\u0026thinsp;=\u0026thinsp;Intention-to-Treat; PP\u0026thinsp;=\u0026thinsp;Per-Protocol. Statistical analysis was performed using the χ\u0026sup2; test. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. No significant differences in eradication rates were observed between the two groups.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidence of adverse reactions\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGroup (Therapy Regimen)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNumber of Patients\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(Completed Protocol)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eAdverse Reactions [n\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(%)]\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eExperimental Group (High-Dose Dual Therapy)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e118\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11(9.32%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eControl Group (Bismuth-Containing Quadruple Therapy)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e105\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e13(12.38%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eX\u0026sup2;\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.629\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eP\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.428\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote : Combined with Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the χ2 value of the adverse reaction rate of the two and quadruple therapies was 0.629, and the P value was 0.428 ( P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ), indicating that there was no statistical significance in the adverse reaction rate of Helicobacter pylori eradication by different medication methods.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eDetails of adverse reactions\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAdverse Reaction Type\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eExperimental Group (High-Dose Dual Therapy) [n\u0026thinsp;=\u0026thinsp;118]\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eControl Group (Bismuth-Containing Quadruple Therapy)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e[n\u0026thinsp;=\u0026thinsp;105]\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDizziness/Headache\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTaste Disturbance\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAbdominal Discomfort\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDiarrhea\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTotal Adverse Reactions\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote :Data are presented as the number of patients with adverse reactions; totals correspond to the adverse reaction counts in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. No severe adverse reactions were reported in either group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnivariate analysis of H.pylori treatment failure [ case ( % ) ]\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFactor\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal Patients\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eNumber of Treatment Failures\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eFailure Rate\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eχ\u0026sup2;\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eP\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTherapy Regimen\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.20\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.655\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHigh-Dose Dual Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e118\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.42%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBismuth-Containing Quadruple Therapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e105\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.86%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDiabetes Mellitus\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.011\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e40.54%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e186\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e20.97%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAnxiety Status\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.017\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e35.59%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e164\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e20.12%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.239\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.040\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e105\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e31.43%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e118\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e18.64%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHypertension\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.194\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.660\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e46\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e21.74%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e177\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.86%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCoronary Heart Disease\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.289\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.130\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e12%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e198\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e51\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.76%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: Univariate analysis was performed using the χ\u0026sup2; test. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Total patients correspond to those who completed the treatment protocol (n\u0026thinsp;=\u0026thinsp;223).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eMultivariate Logistic regression analysis of H.pylori treatment failure\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eβ\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eWald\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eP\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eOR\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e95% CI\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDiabetes\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.241\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.407\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.304\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.002\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.461\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.559\u0026mdash;7.684\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAnxiety state\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.068\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.359\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.824\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.003\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.909\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.438\u0026mdash;5.886\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSexuality\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.751\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.332\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.114\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.024\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.472\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.246\u0026mdash;0.905\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eConstant\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.208\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.458\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.185\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.667\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.812\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: Variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis were included in the model. OR\u0026thinsp;=\u0026thinsp;Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates a statistically significant independent risk factor for treatment failure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Helicobacter pylori, Elderly population, High-dose dual therapy, Bismuth-containing quadruple therapy, Efficacy, Influencing factors, Hainan Province","lastPublishedDoi":"10.21203/rs.3.rs-8173102/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8173102/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo compare the efficacy of high-dose dual therapy and bismuth-containing quadruple therapy in the treatment of Helicobacter pylori (H. pylori) infection in the elderly aged ≥ 60 years in Hainan Province, and to analyze the effects of gender, hypertension, diabetes mellitus, coronary heart disease, and anxiety status on therapeutic outcomes, so as to provide a reference for the precise treatment of H. pylori infection in the elderly population in Hainan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eClinical data were retrospectively collected from the H. pylori infection database of the Gastroenterology Outpatient Department, the Second Affiliated Hospital of Hainan Medical University, from January 2024 to August 2025. Eligible patients were aged ≥ 60 years and had completed a follow-up ¹³C urea breath test at least 4 weeks after the end of initial treatment. Patients were divided into two groups according to the treatment regimen:\u003c/p\u003e\n\u003cp\u003e• Experimental group (high-dose dual therapy): Esomeprazole 20mg / Ilaprazole 5mg / Vonoprazan 20mg, bid (twice daily) + Amoxicillin 1.0g, tid (three times daily);\u003c/p\u003e\n\u003cp\u003e• Control group (bismuth-containing quadruple therapy): Esomeprazole 20mg / Ilaprazole 5mg, bid + Bismuth Potassium Citrate 240mg, bid + Amoxicillin 1.0g, bid + Furazolidone 100mg, bid.\u003c/p\u003e\n\u003cp\u003eThe treatment course for both groups was 14 days. The intention-to-treat (ITT) eradication rate, per-protocol (PP) eradication rate, and incidence of adverse reactions were compared between the two groups. Univariate analysis and multivariate Logistic regression analysis were used to evaluate the effects of gender, hypertension, diabetes mellitus, coronary heart disease, and anxiety status on treatment failure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eA total of 230 patients were included, with 123 in the experimental group and 107 in the control group. In the experimental group, the ITT eradication rate was 71.54% (88/123) and the PP eradication rate was 74.58% (88/118); in the control group, the ITT eradication rate was 75.70% (81/107) and the PP eradication rate was 77.14% (81/105). There was no significant difference in eradication rates between the two groups (all P \u0026gt; 0.05). The incidence of adverse reactions in the experimental group was 9.32% (11/118), which was lower than that in the control group (12.38%, 13/105), though the difference was not statistically significant (χ² = 0.541, P = 0.462). Adverse reactions in the experimental group were mainly mild abdominal distension and diarrhea, while those in the control group were mainly oral odor, dizziness, and headache.Univariate analysis showed that diabetes mellitus (χ² = 6.44, P = 0.011), anxiety status (χ² = 5.66, P = 0.017), and gender (χ² = 4.239, P = 0.040) were associated with H. pylori treatment failure. Multivariate Logistic regression analysis revealed that diabetes mellitus (OR = 3.461, 95% CI = 1.559–7.684, P = 0.002), anxiety status (OR = 2.909, 95% CI = 1.438–5.886, P = 0.003), and gender (OR = 0.472, 95% CI = 0.246–0.905, P = 0.024) were independent risk factors for H. pylori treatment failure. Hypertension and coronary heart disease had no significant impact on therapeutic outcomes (all P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eIn the treatment of H. pylori infection in the elderly aged ≥ 60 years in Hainan Province, high-dose dual therapy has comparable efficacy to bismuth-containing quadruple therapy, but the former has fewer adverse reactions and a lower cost. Gender, diabetes mellitus, and anxiety status are independent risk factors for treatment failure. Clinical treatment should focus on these patients and strengthen targeted interventions.\u003c/p\u003e","manuscriptTitle":"Efficacy Comparison and Analysis of Influencing Factors of High-Dose Dual Therapy vs. Bismuth-Containing Quadruple Therapy for Helicobacter pylori Infection in Elderly Patients in Hainan Province","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 04:29:21","doi":"10.21203/rs.3.rs-8173102/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fbb7b5b1-835d-422b-bfd6-1f2b5674f669","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T08:25:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-23 04:29:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8173102","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8173102","identity":"rs-8173102","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}