Miehlke S, et al. – This single–center cohort study aimed to investigate the efficacy of three–in–one capsule bismuth quadruple therapy (BQT) for Helicobacter pylori eradication in clinical practice in a multinational patient population. For treatment of H. pylori infection in routine practice, three–in–one capsule bismuth quadruple therapy was effective and safe, irrespective of the patient's migrational background or the number of previous treatment failures.

• The physicians examined consecutive H. pylori-positive patients in whom three-in-one capsule BQT (Pylera + omeprazole) has been prescribed.
• They instructed all patients in a standardized fashion.
• They planned a prospective follow-up.
• They performed PCR on gastric biospies for clarithromycin and levofloxacin resistance before treatment in a subgroup of patients.
• They assessed treatment outcome by 13C urea breath test or by histology not earlier than 4 weeks after end of treatment.

• In 322 patients, the prescription involved three-in-one capsule BQT.
• Around 70.2% of patients had a migrational background.
• In 163 patients, PCR results were available and identified resistance to clarithromycin and levofloxacin in 29 (17.8%) and 20 (12.3%) of cases, respectively.
• In 74%, 17%, and 9% of cases, BQT was prescribed as first-line, second-line, and salvage treatments, respectively.
• Because of side effects, 5 patients discontinued treatment (1.8%).
• The overall H. pylori eradication rates were 95.0% (95% CI 94.92%-95.08%) and 96.7% (95% CI 94.6%-98.8%), by modified intention-to-treat and per-protocol analyzes, respectively.
• As per the outcomes, the low number of treatment failures (n = 9) did not allow to identify risk factors for failure.