胃癌（GC）是全世界最致命的恶性肿瘤之一。幽门螺杆菌是GC的主要原因；因此，根除它可以降低发生这种肿瘤的风险。有大量证据表明四联疗法与欧洲人群相关。然而，在拉丁美洲，数据很少。此外，关于欧洲和拉丁美洲人群中抗生素方案所实现的根除率的信息有限。 比较六个中心标准三联疗法 (STT)、四联联合疗法 (QCT) 和铋四联疗法 (QBT) 的有效性基于 2017 年至 2022 年的 LEGACy 登记库进行了一项回顾性研究。数据来自在葡萄牙、西班牙、智利、墨西哥和巴拉圭招募的确诊幽门螺杆菌感染、接受根除治疗和确证的成年患者。包括至少间隔 1 个月的测试。使用混合多级泊松回归比较每个方案的治疗成功率，调整患者性别和年龄，以及国家特定变量，包括幽门螺杆菌抗生素耐药性（克拉霉素、甲硝唑和阿莫西林）的流行率和 CYP2C19 多态性。 772纳入患者（64.64% 为女性；平均年龄 52.93 岁）。 STT 总幽门螺杆菌根除率为 75.20%（255/339），QCT 为 88.70%（159/178），QBT 为 91.30%（191/209）。与 STT 相比，两种四联疗法 (QCT-QBT) 的根除率均显着提高，调整后的发病风险比 (IRR) 为 1.25（p：<0.05）；和 1.24（p：<0.05）。不同国家的抗生素耐药性患病率（而非 CYP2C19 多态性患病率）对根除成功具有统计学上的显着影响。根据国家/地区特定的抗生素耐药性和 CYP2C19 多态性进行调整后，QCT 和 QBT 在根除幽门螺杆菌方面均优于 STT。居住在两大洲五个国家的个人样本。© 2024 作者。 《联合欧洲胃肠病学杂志》由 Wiley periodicals LLC 代表联合欧洲胃肠病学出版。

Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations.To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America.A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms.772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success.Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.