Efficacy and Safety of 14-day Concomitant Therapy for Difficult-to-Treat Helicobacter Pylori Infection

Inclusion Criteria: * Patients aged 18-70 with persistent H. pylori infection. * Patients failed at least three different standard eradication therapies before.Previous standard eradication therapy was defined as a 10-day or 14-day quadruple regimen designed according to Maastricht V report. Exclusion Criteria: * Patients treated with H2-receptor antagonist, PPI, vonoprazan,bismuth and antibiotics in the previous 4 weeks. * Patients with gastorectomy, acute GI bleeding and advanced gastric cancer. * History of allergy to any of the drugs used in the study. * Severe concomitant cardiovascular, respiratory, or endocrine diseases,clinically significant renal or hepatic disease, hematologic disorders and any other clinically significant medical condition that could increase risk. * Currently pregnant or lactating. * Severe neurologic or psychiatric disorders. * Alcohol abuse or drug addiction. * Patients with compliance lower than 90% in any previous treatment are not included. * Inability to provide informed consent and other situations that could interfere with the examination or therapeutic protocol.