Evidence map›Paper›PMID 41413744›Full record

ArticleIndian journal of gastroenterology : official journal of the Indian Society of Gastroenterology2025

Concomitant versus reverse hybrid therapy for eradication of Helicobacter pylori infection-An open-label randomized controlled trial.

D K Ratul, Sathasivam Sureshkumar, Amaranathan Anandhi, Shivakumar Madan, Balakrishnan Gurushankari, Jharna Mandal, Vikram Kate

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Article in Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. [Evidence-Based Guidelines for the Diagnosis and Treatment ofThe Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2026
    Guideline
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

D K RatulDepartment of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India.
Sathasivam SureshkumarDepartment of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India.
Amaranathan AnandhiDepartment of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India.
Shivakumar MadanKidwai Memorial Institute of Oncology, Bangalore 560 029, India.
Balakrishnan GurushankariCancer Institute Womens' Indian Association, Chennai 600 020, India.
Jharna MandalDepartment of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605 006, India.
Vikram KateDepartment of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India. drvikramkate@gmail.com.ORCID http://orcid.org/0009-0006-3104-1421

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDue to the declining efficacy of the earlier regimens for Helicobacter pylori eradication because of anti-microbial resistance, non-bismuth quadruple (concomitant) and reverse-hybrid regimens are emerging as a new regimen. We compared eradication efficacy, compliance and adverse effects of concomitant therapy (CT) vs. reverse-hybrid therapy (RHT).

methodsThis was a prospective, single-centre, parallel-arm, open-label, non-inferiority randomized controlled study. Clinical Trials Registry-India: CTRI/2021/10/047865. Patients with peptic ulcer disease and gastritis found to be H. pylori positive were randomized 1:1 to concomitant therapy: omeprazole 20 mg twice daily (BD), amoxicillin 1 gm BD, clarithromycin 500 mg BD, metronidazole 400 mg thrice daily (TDS) for 14 days and reverse hybrid therapy groups omeprazole 20 mg BD and amoxicillin 1 g BD for 14 days plus clarithromycin 500 mg BD and metronidazole 400 mg TDS for the first seven days. Eradication was assessed six weeks post-therapy and compliance and adverse effects were noted.

resultsTotal 148 patients were randomized to 74 in CT and RHT groups. Baseline features were comparable; mean age 44.5 ± 13.9 vs. 43.7 ± 13.5 years; males 56.8% vs. 58.1%. Eradication (CT vs. RHT) was 59 (79.7%) vs. 62 (83.7%) (intention-to-treat [ITT], p = 0.52), 59 (86.7%) vs. 62 (88.5%) (modified ITT, p = 0.74) and 59 (92.2%) vs. 62 (92.5%) (per-protocol, p = 0.94) analysis. Compliance was good and similar in both groups by per-protocol 64/70 (91.4%) vs. 67/71 (94.4%) (p = 0.497) and ITT 64/74 (86.5%) vs. 67/74 (90.5%) (p = 0.439) analysis. Adverse effects occurred at similar frequencies; the most common was altered taste 33/68 (48.5%) vs. 30/70 (42.9%) (p = 0.50). Overall, 98 adverse events were recorded in CT and 75 in RHT (1.44 vs. 1.07 events/patient; rate ratio 1.35, 95% CI 1.00-1.82; p = 0.053).

conclusionFourteen-day concomitant and reverse-hybrid regimens achieved comparable eradication, with similar compliance and no difference in overall adverse events.

Indexed as

ComplianceConcomitant therapyEradication rateH. pyloriReverse hybrid therapy

Identifiers

PMID41413744

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.