Effect of bismuth-containing quadruple therapy with amoxicillin and clarithromycin on liver function in patients with Helicobacter pylori infection complicated with non-alcoholic simple fatty liver disease

Zhang Lingyun; Li Huimin; Si Xiaobei; Zhang Yuexia; Qiao Lei; Lan Yu

doi:10.3760/j.issn.1673-4777.2026.02.011

Abstract：Objective To investigate the effect of bismuth-containing quadruple therapy with amoxicillin and clarithromycin on liver function in patients with Helicobacter pylori(Hp)infection complicated with non-alcoholic simple fatty liver(NAFL).Methods A prospective clinical study was conducted.Patients with Hp infection who were admitted to Beijing Jishuitan Hospital,Capital Medical University from October 2023 to October 2024 were enrolled and divided into the NAFL group and the non-liver disease group according to the presence or absence of NAFL.All patients received 14 d bismuth-containing quadruple therapy with amoxicillin and clarithromycin for Hp eradication.The Hp eradication rate,changes in liver function indexes before and after treatment,and incidence of adverse reactions were compared between the two groups.Results A total of 103 patients were initially enrolled in the study,among whom 3 patients were excluded due to skin rash,complicated pulmonary infection and traumatic surgery respectively,with 100 patients finally included in the observation,50 cases in each of the NAFL group and the non-liver disease group.There were no significant differences in gender,age and Hp eradication rate between the two groups(all P>0.05).The body mass index(BMI)of the NAFL group was significantly higher than that of the non-liver disease group[(26±3)kg/m2 vs(23±3)kg/m2](P<0.001).The liver function indexes of both groups did not exceed 3 times the upper limit of the normal value before and after treatment.After treatment,the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in both groups were signifi-cantly higher than those before treatment(both P<0.05),while there were no significant differences in alkaline phosphatase and gamma-glutamyl transferase(GGT)before and after treatment in both groups(all P>0.05).There were no significant differences in the changes of liver function indexes before and after Hp eradication treatment between the two groups(all P>0.05).The incidence of abnormal liver function after treatment in the NAFL group was significantly higher than that in the non-liver disease group[30.0％(15/50)vs 10.0％(5/50)](P=0.012).Univariate analysis showed that BMI,pre-treatment ALT,AST and GGT were influencing factors for abnormal liver function after treatment(all P<0.05).Multivariate Logistic regression analysis showed that BMI was the only independent influencing factor(odds ratio=1.369,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05),which were mainly digestive system reactions such as taste disturbance,nausea,epigastric discomfort and diarrhea,with no serious adverse reactions reported.Conclusion Bismuth-containing quadruple therapy with amoxicillin and clarithromycin can cause liver injury mainly characterized by elevated ALT and AST levels regardless of the presence or absence of liver disease,and there is no significant difference in the elevation ranges of ALT and AST between the two groups.The incidence of abnormal liver function after treatment in NAFL patients is significantly higher than that in non-liver disease patients,and increased BMI is an important influencing factor for abnormal liver function after treatment.It is recommended that close monitoring of liver function should be performed during and after treatment in patients with high BMI.