Safety and Efficacy of Esomeprazole-Containing Regimens for Helicobacter pylori Eradication: A Multicenter Retrospective Study

INTRODUCTION: Helicobacter pylori is a major global health challenge, causing significant gastrointestinal diseases and contributing to gastric cancer risk. This study evaluated the safety and efficacy of esomeprazole-containing regimens for H. pylori eradication in treatment-naïve and previously treated patients. METHODS: This retrospective multicenter cohort study included 2,530 patients diagnosed with H. pylori infection. Patients received one of five esomeprazole-containing regimens for 14 days. Eradication was assessed 4-6 weeks post-treatment using stool antigen tests, urea breath tests, or histopathology. Analyses included intention to treat (ITT) and per protocol (PP). Demographics, socioeconomic status, prior treatment history, adverse events, and eradication rates were analyzed. RESULTS: Of 2,530 enrolled, 2,489 were analyzed per protocol. The overall eradication rate was 87.3% (ITT) and 88.7% (PP). Treatment-naïve patients achieved higher eradication rates (89.7%) compared with previously treated patients (85.2%, p = 0.003). Bismuth subcitrate-based (96.5% PP in naïve; 86.7% in experienced) and doxycycline-based regimens (92.3% PP in naïve; 84.3% in experienced) demonstrated the highest efficacy. Adverse events occurred in 34.9% of patients, with no severe events. Socioeconomic status influenced outcomes, with eradication rates of 90.8% in high, 89.4% in middle, and 80.0% in low SES groups (p = 0.0001). CONCLUSIONS: Esomeprazole-containing regimens are effective and well tolerated for H. pylori eradication. Bismuth- and doxycycline-based quadruple therapies achieved the highest eradication rates, particularly in treatment-naïve patients. Tailored strategies incorporating bismuth or quadruple therapy may benefit patients with prior treatment failures or from lower socioeconomic backgrounds. Further research should consider regional resistance patterns and prospective designs.