{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T02:35:15Z","timestamp":1768876515783,"version":"3.49.0"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Journal of Gastroenterology and Hepatology"],"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p><jats:italic>Aim.<\/jats:italic>There is a paucity of data on the efficacy of empiric<jats:italic>H. pylori<\/jats:italic>treatment after multiple treatment failures. The aim of this study is to examine the efficacy of empiric salvage therapy as a second through sixth line treatment.<jats:italic>Methods.<\/jats:italic>In this single gastroenterology center prospective study in Montreal, Canada, patients with failed<jats:italic>H. pylori<\/jats:italic>treatment were offered empiric salvage therapy based on the patients\u2019 previous antibiotic exposure. Enrollment occurred after 1\u20135 previous failed attempts and eradication determined at least 4 weeks after completion of treatment.<jats:italic>Results.<\/jats:italic>205 treatments were attempted in 175 patients using 7 different regimens. Eradication was achieved in 154 attempts (PP = 81% (154\/191), ITT = 75% (154\/205)). Bismuth quadruple therapy (BQT) had higher eradication success (PP = 91% (102\/112), ITT = 84% (102\/121)) when compared to all PPI triple therapies combined (PP = 66% (49\/74), absolute risk reduction (ARR): 25% (95% CI: 13\u201337), ITT = 62% (49\/79), ARR: 22% (95% CI: 10\u201335), and<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn fontstyle=\"italic\">0.001<\/mml:mn><\/mml:math>) and when compared to levofloxacin triple therapy (PP = 66% (40\/61), ARR: 26% (95% CI: 13\u201339), ITT = 61% (40\/66), and ARR: 24% (95% CI: 10\u201337)). Eradication was achieved in a high proportion with BQT on attempt two (PP = 94% (67\/71), ITT = 91% (67\/74)), three (PP = 85% (17\/20), ITT = 71% (17\/24)), four (PP = 100% (11\/11), ITT = 92% (11\/12)), and five (PP = 86% (6\/7), ITT = 75% (6\/8)). Patients with previous combined bismuth and tetracycline exposure had a lower proportion of eradication compared to patients without such an exposure (PP: 60% (6\/10) versus 95% (94\/99), ARR: 35% (95% CI: 11\u201364), and<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn fontstyle=\"italic\">0.001<\/mml:mn><\/mml:math>; ITT: 55% (6\/11) versus 90% (94\/105), ARR: 35% (95% CI: 10\u201362), and<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn fontstyle=\"italic\">0.01<\/mml:mn><\/mml:math>).<jats:italic>Conclusions.<\/jats:italic>Salvage therapy with a bismuth quadruple regimen is superior to triple therapies and is effective for second through fifth line empirical treatment (\u226585% PP, \u226570% ITT). Successful eradication is significantly lower with BQT if a similar bismuth based regimen was used in the past.<\/jats:p>","DOI":"10.1155\/2016\/7321574","type":"journal-article","created":{"date-parts":[[2016,3,29]],"date-time":"2016-03-29T18:47:49Z","timestamp":1459277269000},"page":"1-8","source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of Second through Sixth Line Salvage<i>Helicobacter pylori<\/i>Treatment: Bismuth Quadruple Therapy is Almost Always a Reasonable Choice"],"prefix":"10.1155","volume":"2016","author":[{"given":"Tahir","family":"Shaikh","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada H4A 3J1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1686-5047","authenticated-orcid":true,"given":"Carlo A.","family":"Fallone","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, McGill 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