Effective treatment with a 4-drug regimen.

The online newspaper Dan Tri published an article titled "Gastric ulcers caused by drug-resistant H. pylori: Effective treatment with a 4-drug regimen" on May 9, 2025. To update our readers, we will quote content from Dan Tri newspaper for your information.

Quote the entire content of the article.

One of the reasons why stomach diseases are often difficult to cure is the development of antibiotic resistance in H. pylori bacteria. Therefore, updating treatment protocols is crucial in treating this condition.

Helicobacter pylori (HP) bacteria are one of the leading causes of peptic ulcers and also contribute to the risk of gastrointestinal bleeding and even stomach cancer. In Vietnam, the HP infection rate is approximately 70-80%, depending on the study, and not all cases of HP infection require treatment. Treatment is necessary for cases of HP infection accompanied by symptoms of stomach disease and damage in the stomach such as inflammation, ulcers, or those with risk factors that increase the likelihood of stomach cancer.

However, treating H. pylori infection today is not a simple matter. Previously, from the 2000s onwards, H. pylori was very sensitive to antibiotics and easy to eradicate. Today, however, antibiotic resistance is very high in Vietnam, making H. pylori eradication increasingly difficult.

The case of patient Nguyen Thi V. (54 years old, Hanoi ) is a clear example of antibiotic resistance in H. pylori bacteria. On July 16, 2024, Ms. V. came to the Gastroenterology Department of Thu Cuc International General Hospital with dull pain in the epigastric region, bloating, no fever, and no vomiting.

Upon examination, the doctor noted a 1.5 cm ulcer at the lesser curvature of the stomach, with a blood clot and active bleeding, along with a positive test for Helicobacter pylori (H. pylori) bacteria. Ms. V's case is a severe H. pylori infection accompanied by an ulcer, therefore treatment for the ulcer and H. pylori eradication are necessary. At Thu Cuc International General Hospital, doctors treated the ulcer to stop the bleeding; however, Ms. V requested a transfer to another hospital for further treatment.

Mrs. V's endoscopy results from July 2024 – Ulcer at the lesser curvature angle with active gastrointestinal bleeding.

Representatives from Thu Cuc International General Hospital stated that at the other hospital where Ms. V was transferred, she was treated with a three-drug regimen including PPIs, Klacid, and Amoxicillin for 14 days, but her symptoms did not significantly improve. In October 2024, Ms. V returned to Thu Cuc International General Hospital for a follow-up examination. After examination, doctors found that the old ulcer had not healed, was still swollen, and had many pseudomembranes. Furthermore, the H. pylori test still showed a positive result. This is a typical case demonstrating the failure of treatment regimens due to drug-resistant H. pylori bacteria.

Ms. V's endoscopy results from October 2024: The ulcer is still present.

Using a four-drug regimen in the treatment of drug-resistant H. pylori.

After assessing Ms. V's condition, Thu Cuc International General Hospital prescribed a new treatment regimen consisting of four drugs: PPI, Bismuth, Tetracycline, and Metronidazole, for 14 consecutive days. Ms. V followed the treatment instructions precisely. At the end of the course, unpleasant symptoms such as abdominal pain, bloating, and nausea disappeared, her appetite improved, and her sleep also significantly improved. On March 20th, a follow-up endoscopy showed that the stomach ulcer had healed, with no more edema or pseudomembrane. Simultaneously, the H. pylori test result was negative.

The doctor examines and advises the patient.

According to Associate Professor Dr. Vu Van Khien, Secretary General of the Vietnam Gastroenterology Association, who is also the Deputy Director in charge of gastrointestinal endoscopy at Thu Cuc International General Hospital and Vice President of the Vietnam Gastroenterology Association, in 2022, the Association reached a consensus on the diagnosis and treatment of H. pylori eradication, recommending the use of a 4-drug regimen containing bismuth. “Applying this specifically to this patient, we used the 4-drug regimen containing bismuth for 14 days and the results were excellent. The ulcer healed and the H. pylori bacteria were eradicated,” he said.

Ms. V's endoscopy results in March 2025: The ulcer has healed.

Associate Professor Dr. Vu Van Khien added that, according to recommendations from the Vietnam Gastroenterology Association and the world , when the rate of clarithromycin resistance in the population exceeds 20%, treatment regimens should be reconsidered. Currently, the rate of H. pylori resistance in Vietnam is increasing (clarithromycin resistance: 34%, Metronidazole resistance: 70%), so the 3-drug regimens (PPI + Amoxicillin and Klacid) have reduced effectiveness in eradicating H. pylori and prevent ulcer healing. The Vietnam Gastroenterology Association recommends using a 4-drug regimen containing bismuth as a preferred option in cases of treatment failure.

Modern gastroscopy and colonoscopy technology at Thu Cúc TCI

Thu Cuc International General Hospital is one of the pioneering hospitals in updating the latest treatment protocols from both domestic and international sources for H. pylori infection, as well as digestive diseases in general, to ensure optimal treatment effectiveness and minimize drug resistance. Associate Professor Khien stated that most patients treated here experience positive results after one course of intensive treatment using internationally standardized protocols. However, in exceptional cases, some patients who do not respond to classic treatment protocols due to strong drug resistance will be prescribed new, specific protocols by the doctors.

Thu Cúc TCI Healthcare System is a trusted address for examination and treatment of digestive diseases, bringing together a team of highly qualified doctors and modern endoscopic technology. For more details, please see:

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