This study tested the influence of pretreatment bacterial density on the eradication rate of Helicobacter pylori with triple therapy. One hundred and thirty two patients with endoscopically confirmed H pylori positive, duodenal ulcer or antral gastritis were treated with triple therapy (colloidal bismuth/metronidazole/amoxicillin) for two weeks. Pretreatment urease activity was assessed by the "4C-urea breath test (UBT) in all patients. The mean (SD) pretreatment UBT concentration was similar in patients with duodenal ulcers (318.4 (175.0)) and patients with antral gastritis (288.9 (165.5)). Rauws et al have shown that one of the advantages of the urea breath test in the diagnosis of H pylori infection is that it also gives a quantitative assessment of the bacterial density in the stomach and correlates well with the histological findings.'1 This correlation has been validated recently by several independent studies. 12-14The purpose of this study was to evaluate the eradication rate of triple therapy in our patient population, and to examine the effect of the pretreatment bacterial density assessed by the 14C-urea breath test (UBT), on the eradication rate with this regimen. MethodsThe study included patients referred to our gastroenterology service for upper gastrointestinal symptoms, who were found to have endoscopically verified duodenal ulcers or chronic antral gastritis. During endoscopy prepyloric antral biopsy specimens were taken for histological examination and for rapid urease testing. In all patients 14C-UBT was performed before starting treatment for H pylori eradication. Patients were treated with the regimen: colloidal bismuth subcitrate (CBS, De-Nol) 120 mg four times daily, amoxicillin 500 mg thrice daily, and metronidazole 250 mg twice daily for 14 days. All the patients underwent a 14C-UBT four weeks after completion of the treatment for evaluation of H pylori eradication.

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One-week low-dose triple therapy with OCT is highly effective as an initial therapy in eradicating H. pylori infection. The efficacy is significantly lower when given as a second line treatment in patients who have previously failed to eradicate H. pylori with bismuth-based standard triple therapy.