Objective:

To evaluate the differences in eradication efficacy among various H. pylori treatment regimens and the impact of prescription appropriateness on treatment outcomes based on real-world clinical data.

Approach:

• Study Design: Single-center retrospective observational study involving 897 patients with confirmed H. pylori infection from September 2022 to September 2025.
• Data Collection: Data extracted from electronic medical records included demographic characteristics, clinical information, treatment regimens, and outcomes measured by 13C-urea breath tests.
• Statistical Analysis: Multivariable logistic regression and stratified analyses were performed to assess factors associated with eradication success and follow-up adherence.

Key Findings:

• Overall ITT and PP eradication rates were 79.04% and 90.23%, respectively.
• Quadruple therapy achieved the highest eradication rates (ITT: 81.42%; PP: 93.76%).
• Prescription appropriateness significantly affected eradication rates in the quadruple therapy group (p < 0.01).
• Female gender was associated with higher eradication success in the quadruple therapy group (OR = 2.53, 95% CI: 1.15–5.73).
• Older patients and those using traditional Chinese medicine (TCM) demonstrated better follow-up compliance.

Interpretation:

Clinical practice should prioritize guideline-recommended regimens, as actual eradication effectiveness may vary depending on the regimen selected.

Limitations:

• The study was conducted at a single center, which may limit generalizability.
• Retrospective design may introduce biases in data collection and analysis.

Conclusion:

Bismuth-containing quadruple therapy should be used in strict accordance with guideline standards.