Dore MP, Bibbò S, Loria M, et al. - In this two open-label randomized pilot studies involving 99 patients researchers examined the effectiveness of a BID quadruple therapy containing Pylera or Lactobacillus reuteri for Helicobacter pylori infection, defined as the presence of bacteria on gastric biopsies histological examination and/or a positive 13C-Urea Breath Test or stool antigen test. Adult H pylori-positive patients were randomly assigned to BID therapy with quadruple therapy containing bismuth (2 capsules of Pylera plus 250 mg each of tetracycline and metronidazole for a total of 500 mg of each), or the same dose of antibiotics plus 2 × 10⁸ CFU L reuteri DSM 17 938 plus 2 × 10⁸ CFU L reuteri ATCC PTA 6475 (Gastrus) once daily and pantoprazole 20 mg BID. In the treatment of naïve patients in Sardinia, BID bismuth quadruple therapy was extremely efficient for H pylori eradication. If bismuth is contraindicated or unavailable, replacement of bismuth with Gastrus could be considered.