The pathogenic role of Helicobacter pylori in chronic active gastritis and its association with duodenal ulcer disease in 95±99% of patients is well established. 1 Therefore the 1994 National Institute of Health (NIH) consensus development conference recommended the eradication of H. pylori in all patients with documented peptic ulcer disease. 2 The ideal eradication regimen remains elusive; previously used double regimens (omeprazole plus amoxycillin) had a success rate ranging from 30 to 80%. 3 The aim of this study was to compare the ef®cacy of either omeprazole or ranitidine combined in a quadruple regimen including tripotassium dicitrato bismuth, metronidazole and tetracycline hydrocloride as a second-line treatment in patients with erosive duodenitis or duodenal ulcer in whom a non-metronidazole-based anti-H. pylori therapy had previously failed. Currently used eradication regimens show ef®cacy ranging from 80 to 95%. 4 Quadruple therapy comprising a proton pump inhibitor in combination with bismuth triple therapy appears to produce the highest eradication rates

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