***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Helicobacter Pylori ( H. Pylori ) is the most common cause of peptic ulcer disease ( PUD ) and represents a strong risk factor for gastric cancer . Treatment of H. Pylori is , therefore , a persistent need to avoid serious medical complications . Resistance to antibiotics remains to be the major challenge for H. Pylori eradication . In this study , we determined the prevalence of H. pylori infection and evaluated H. pylori eradication efficacy of bismuth-containing quadruple therapy ( Pylera ) versus 14-days sequential therapy in treatment naïve-Lebanese patients . 1030 patients , showing symptoms of peptic ulcer ( PU ) and gastritis , underwent 14C-Urea Breath Test and esophagogastroduodenoscopy to examine H. Pylori infection and gastrointestinal disorders . Among the H. Pylori-positive patients 60 individuals were r and omly selected , separated into two groups ( each consisting of 30 patients ) and treated with either bismuth-containing quadruple therapy or 14-days sequential therapy . We show that of the 1050 patients tested : 46.2 % were H. pylori-positive , 55 % had gastritis , 46.2 % had both gastritis and H. pylori infection , 8.8 % had gastritis but no H. pylori infection , 44.9 % had neither gastritis nor H. pylori infection . Following the 14-days sequential therapy , the eradication rate was significantly higher than that obtained upon using bismuth-containing quadruple therapy [ 80 % ( 24/30 ) versus 50 % ( 15/30 ) , χ2 = 5.93 , P = 0.015 ] . In conclusion , we determined H. pylori and gastritis prevalence among Lebanese PU- patients and showed that 14-days sequential therapy is more efficient  than bismuth-containing quadruple therapy in terms of H. Pylori-eradication Objectives To assess the efficacy and safety of omeprazole given with the new single capsule of bismuth , metronidazole and tetracycline ( OBMT ) compared with quadruple treatment consisting of omeprazole , bismuth , amoxicillin and clarithromycin ( OBAC ) for Helicobacter pylori eradication in duodenal ulcer patients . Methods This single-blind , r and omized multicentre trial was conducted in 10 tertiary hospitals in China between January 2013 and April 2014 . Patients were r and omized to receive 10 days of OBMT therapy or 10 days of OBAC therapy . Our primary outcome was the H. pylori eradication rate , confirmed by negative [13C]urea breath tests 20 - 25 days after the end of omeprazole maintenance . Antibiotic resistance was determined by Etest . This study is registered with Clinical Trials.gov , number ChiCTR-TRC-13003143 . Results One hundred and ninety-two patients received OBMT therapy and 192 received OBAC therapy . There was no significant difference between the eradication rates achieved by OBMT and OBAC in either the ITT analysis ( 86.46 % versus 87.50 % , P = 0.762 ) or the PP analysis ( 94.58 % versus 93.06 % , P = 0.563 ) . The efficacies of  OBMT and OBAC were not affected by metronidazole or clarithromycin resistance . Treatment-emergent adverse events ( TEAEs ) for both treatments were similar ; gastrointestinal and CNS symptoms were the most commonly reported . Conclusions The new single-capsule OBMT quadruple therapy is as effective and well tolerated as the widely used OBAC therapy for treatment of H. pylori in clinical practice in China . In addition , this OBMT therapy largely overcomes H. pylori metronidazole and clarithromycin resistance BACKGROUND AND AIMS H. pylori eradication is strongly affected by various factors , including the ongoing antibiotic resistance . We describe a " real life " scenario in patients managed for H. pylori-related conditions , living in a southern Italian region ( Apulia ) , an area with clarithromycin resistance > 15 % . METHODS 2,224 subjects were studied in two tertiary referral centers in Apulia . Analyses included : reason for referral , H. pylori infection rates ( 13C-urea breath test - UBT or upper endoscopy ) , and eradication rates following distinct regimens previously prescribed or prospect ively prescribed ( such as the bismuth-based quadruple therapy Pylera ® , recently marketed in Italy ) . RESULTS Over 80 % of the patients were referred by family physicians ( 60 % naïve subjects ) . The overall infection rate was 32.5 % and it was similar in asymptomatic patients ( 31.1 % ) or with H. pylori-related symptoms/ clinical conditions ( 34.3 % ) . In the 987 H. pylori+ve patients receiving therapy , the overall eradication rate was 80.2 % ( ITT ) . Observed eradication rate varied greatly across different regimens : 57.1 % ( 2nd line levofloxacin ) , 59.6 % ( unconventional ) , 70.7 % ( 7-day triple ) , 73.2 % ( 7-day undefined ) , 89 % ( 10-day sequential ) and 96.9 % ( ITT , 10 day Pylera ® , 1st to 5th line regimens given to 227 patients ) . CONCLUSIONS A heterogeneous " real life " scenario in Southern Europe shows that H. pylori+ve patients are put at risk of poor outcomes and points to the need of a susceptibility-based therapy according to guidelines and local microbial resistance . In the present setting ( i.e. high clarithromycin resistance ) , despite the high observed eradication rate , sequential therapy should not be recommended ( absent in guidelines , unneeded antibiotic ) . Bismuth-based quadruple treatment ( 1st , 2nd or subsequent lines ) yields the highest eradication rates Bismuth  quadruple therapy ( BQT )  has been proven superior to st and ard triple therapy for Helicobacter pylori eradication in r and omized clinical trials ; however , little is known about the efficacy of BQT in daily routine practice Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Current Italian guidelines recommend 10-day bismuth-based or bismuth-free ( sequential and concomitant ) regimens for first-line H. pylori eradication . However , comparison among these regimens is lacking in our country . AIM To perform a ' head-to-head ' comparison among these three therapies as first-line treatment for H. pylori eradication in clinical practice . METHODS This was a prospect i ve , open-label r and omized study enrolling consecutive patients diagnosed with H. pylori infection never previously treated . Patients were r and omized to receive one of the following 10-day therapies : ( a ) Bismuth-based therapy : esomeprazole 20 mg b.i.d and Pylera 3 tablets q.i.d ; ( b ) Concomitant therapy : esomeprazole 20 mg plus amoxicyllin 1,000 mg , clarithromycin 500 mg and tinidazole 500 mg ( all b.i.d . ) , and ( c ) Sequential therapy : esomeprazole 20 mg plus amoxicyllin 1,000 mg for 5days followed by esomeprazole 20 mg plus clarithromycin 500 mg and tinidazole 500 mg for 5days ( all b.i.d ) . H. pylori eradication was assessed by using UBT 4 - 6 weeks after the end of therapy . RESULTS Overall , 187 patients were enrolled . The eradication rates achieved with Pylera , concomitant and sequential were 85.2 % , 95.2 % , and 93.6 % , respectively , at intention to treat , and 94.5 % , 96.7 % , and 95.1 % at per protocol analyses , without a statistically significant difference . The incidence of severe side-effects was higher with the bismuth-based therapy than with the two bismuth-free regimens ( 9.8 % vs 1.6 % ; p=0.046 ) . CONCLUSIONS Bismuth-based and bismuth-free therapies are equally effective for first-line H. pylori eradication . However , bismuth therapy was more frequently interrupted for side-effects than bismuth-free therapies BACKGROUND Helicobacter pylori is associated with benign and malignant diseases of the upper gastrointestinal tract , and increasing antibiotic resistance has made alternative treatments necessary . Our aim was to assess the efficacy and safety of a new , single-capsule treatment versus the gold st and ard for H pylori eradication . METHODS We did a r and omised , open-label , non-inferiority , phase 3 trial in 39 sites in Europe , comparing the efficacy and safety of 10 days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium , metronidazole , and tetracycline ( quadruple therapy ) versus 7 days of omeprazole , amoxicillin , and clarithromycin ( st and ard therapy ) in adults with recorded H pylori infection . Patients were r and omly assigned treatment according to a predetermined list independently generated by Quintiles Canada ( Ville St-Laurent , QC , Canada ) . Our study was design ed as a non-inferiority trial but was powered to detect superiority . Our primary outcome was H pylori eradication , established by two negative (13)C urea breath tests at a minimum of 28 and 56 days after the end of treatment . Our assessment for non-inferiority was in the per- protocol population , with subsequent assessment for superiority in the intention-to-treat population ( ie , all participants r and omly assigned treatment ) . This study is registered with Clinical Trials.gov , number NCT00669955 . FINDINGS 12 participants were lost to follow-up and 101 were excluded from the per- protocol analysis . In the per- protocol population ( n=339 ) , the lower bound of the CI for treatment with quadruple therapy was greater than the pre-established non-inferiority margin of -10 % ( 95 % CI 15·1 - 32·3 ; p<0·0001 ) . In the intention-to-treat population ( n=440 ) , eradication rates were 80 % ( 174 of 218 participants ) in the quadruple therapy group versus 55 % ( 123 of 222 ) in the st and ard therapy group ( p<0·0001 ) . Safety profiles for both treatments were similar ; main adverse events were gastrointestinal and CNS disorders . INTERPRETATION Quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H pylori , especially since quadruple therapy provides superior eradication with similar safety and tolerability to st and ard therapy . FUNDING Axcan Pharma OBJECTIVE To evaluate the efficacy and safety of a quadruple regimen ( BMTO ) of the " 3-in-1 capsule " ( containing bismuth subcitrate potassium , metronidazole and tetracycline ) plus omeprazole in naïve and previously treated patients diagnosed with Helicobacter pylori ( H. pylori ) infection in the clinical setting in Seville ( Spain ) . METHODS This is a prospect i ve study carried out on consecutive patients with a confirmed H. pylori infection and upper gastrointestinal symptoms . After providing their informed consent , the patients were treated for ten days with a 3-in-1 capsule containing bismuth subcitrate potassium ( 140 mg ) , metronidazole ( 125 mg ) and tetracycline ( 125 mg : Pylera ® ) , three capsules four times daily , plus omeprazole ( 20 or 40 mg ) twice daily . Eradication of infection was determined by a negative urea breath test at least 28 days after the end of treatment . RESULTS A total of 58 consecutive patients were enrolled into this study , two of whom withdrew early due to vomiting  on days three and five , respectively . In this cohort , 17 patients ( 29.3 % ) had a prior history of medication to treat H. pylori . In the intent-to-treat population , eradication was achieved in 97.6 % ( 40/41 ) and 82.4 % ( 14/17 ) of cases in patients treated with BMTO as a first-line or rescue therapy , respectively . At least one adverse event was reported by 28 ( 48 % ) patients , mostly mild effects ( 86 % ) . CONCLUSION A ten day treatment with BMTO is an effective and safe strategy to combat confirmed H. pylori infection in patients 
    Output:
    
A 10-day treatment with Pylera ® achieved an effective eradication rate of approximately 90 % both in first- and second-line therapy .
This applies regardless of the type and dose of the PPI , in patients with clarithromycin- or metronidazole-resistant strains , and in those previously treated with clarithromycin