Gastric ulcers caused by drug-resistant HP: Effective treatment with 4-drug regimen

Helicobacter pylori (HP) bacteria is one of the leading causes of peptic ulcers, and is also a factor leading to the risk of gastrointestinal bleeding and even stomach cancer. In Vietnam, the rate of HP infection is about 70-80% depending on each study and not all cases of HP infection require treatment.

Cases requiring treatment are those infected with HP bacteria accompanied by symptoms of gastric disease and damage in the stomach such as inflammation, ulcers, or have risk factors that increase the possibility of stomach cancer.

However, the treatment of HP bacteria today is not a simple story. HP bacteria in the past from the year 2000 were very sensitive to antibiotics so they were easy to destroy. Nowadays, the situation of antibiotic resistance in Vietnam is very high so the treatment to destroy HP is becoming more and more difficult.

The case of patient Nguyen Thi V. (54 years old, Hanoi ) is a clear demonstration of the drug resistance of HP bacteria. On July 16, 2024, Ms. V. came to the Department of Gastroenterology - Thu Cuc International General Hospital with dull pain in the epigastric region, abdominal distension, no fever, no vomiting.

Upon examination, the doctor noted a 1.5cm ulcer at the angle of the lesser curvature of the stomach, with a blood clot and bleeding, and a positive test result for HP bacteria. Ms. V's case was a case of HP infection accompanied by a severe ulcer, so the ulcer needed to be treated and HP eradicated.

At Thu Cuc International General Hospital, doctors treated her ulcer to stop bleeding, however, Ms. V wanted to be transferred to another hospital to continue treatment.

Mrs. V's endoscopy results in July 2024 - Small curvature corner ulcer with gastrointestinal bleeding.

A representative of Thu Cuc International General Hospital said that at another hospital where Ms. V was transferred, she was given a 3-drug regimen including PPI, Klacid and Amoxicillin for 14 days, but her symptoms did not improve significantly.

In October 2024, Ms. V returned to Thu Cuc International General Hospital for a re-examination. After examination, the doctors found that the old ulcer had not healed, was still edematous and had many pseudomembranes, and the HP test was still positive. This is a typical case showing the failure of the treatment regimen due to drug-resistant HP bacteria.

Mrs. V's endoscopy results in October 2024: The ulcer is still there.

Using 4-drug regimen in the treatment of drug-resistant HP bacteria

After assessing Mrs. V's condition, Thu Cuc International General Hospital prescribed a new treatment regimen for Mrs. V including 4 drugs PPI + Bismuth + Tetracycline + Metronidazole for 14 consecutive days. Mrs. V. followed the treatment as directed.

At the end of the treatment, the unpleasant symptoms such as abdominal pain, bloating, nausea were gone, appetite was better, and sleep was also significantly improved. On March 20, when re-examined with endoscopy, the stomach ulcer had healed, no more edema or pseudomembrane. At the same time, the HP test was negative.

Doctor examines and advises patient.

General Secretary of the Vietnam Gastroenterology Association, Associate Professor, Dr. Vu Van Khien, who is also Deputy Director in charge of gastrointestinal endoscopy at Thu Cuc International General Hospital and Vice President of the Vietnam Gastroenterology Association, said that in 2022, the Vietnam Gastroenterology Association reached a consensus on diagnosis and treatment of HP eradication, with a recommendation to use a 4-drug regimen containing Bismuth.

"Applying specifically to this patient, we used a 4-drug regimen containing Bismuth for 14 days and the results were excellent. The ulcer healed and the HP bacteria were eradicated," he said.

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

Associate Professor, Dr. Vu Van Khien added that, according to the recommendations of the Vietnam Gastroenterology Association as well as the world , when the rate of clarithromycin antibiotic resistance in residential areas is over 20%, it is necessary to consider when using the treatment regimen. Currently, the drug resistance of HP in Vietnam is increasing (Clarithromycin resistance: 34%, Metronidazole resistance: 70%), so the 3-drug regimen (PPI + Amoxicillin and Klacid) has reduced the effectiveness of HP eradication and caused ulcers to not heal. The Vietnam Gastroenterology Association recommends using the 4-drug regimen containing Bismuth as a priority option in cases of treatment failure.

Modern colonoscopy technology at Thu Cuc TCI.

Thu Cuc International General Hospital is one of the pioneering hospitals in updating the latest domestic and foreign regimens in the treatment of HP in particular and digestive diseases in general to ensure optimal treatment effectiveness and minimize drug resistance.

Associate Professor Khien said that most of the patients treated here are effective after a period of active treatment with international standard regimens. However, there are some patients who do not respond to the classic treatment regimen due to strong drug resistance and will be prescribed by doctors to continue with new specific regimens.

Thu Cuc TCI Healthcare System is a trusted address for examination and treatment of digestive diseases, gathering a team of highly specialized doctors and modern endoscopic technology. For more information, see:

Website: https://benhvienthucuc.vn/noi-soi-tieu-hoa-ung-dung-cong-nghe-dot-pha/

Consulting hotline: 1900 55 88 92

Source: https://dantri.com.vn/suc-khoe/loet-da-day-do-hp-khang-thuoc-dieu-tri-hieu-qua-voi-phac-do-4-thuoc-20250508172328479.htm