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Review
. 2013 Aug 7:347:f4587.
doi: 10.1136/bmj.f4587.

Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy

Luigi Gatta  1 , Nimish Vakil, Dino Vaira, Carmelo Scarpignato
Affiliations
Review

Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy

Luigi Gatta et al. BMJ. .

Abstract

Objective: To do a systematic review and meta-analysis of studies comparing sequential therapy for eradication of Helicobacter pylori with pre-existing and new therapies, thus providing a glimpse of eradication success worldwide.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, and Cochrane Central Register of Controlled Trials up to May 2013; abstract books of major European, American, and Asian gastroenterological meetings.

Study selection: Randomised controlled trials in previously untreated adults, in which sequential therapy was compared with a pre-existing or new therapy.

Results: 46 randomised controlled trials were reviewed and analysed. 5666 patients were randomised to sequential therapy and 7866 to other (established and new) treatments. The overall eradication rate of sequential therapy was 84.3% (95% confidence interval 82.1% to 86.4%). Sequential therapy was superior to seven day triple therapy (relative risk 1.21, 95% confidence interval 1.17 to 1.25; I(2)=29.3%; number needed to treat 6, 95% confidence interval 5% to 7%), marginally superior to 10 day triple therapy (1.11, 1.04 to 1.19; I(2)= 67.2%; NNT 10, 7 to 15), but not superior to 14 day triple therapy (1.00, 0.94 to 1.06; I(2)=54.3%), bismuth based therapy (1.01, 0.95 to 1.06; I(2)=21.1%), and non-bismuth based therapy (0.99, 0.94 to 1.05; I(2)=52.3%). Data on eradication according to pre-treatment antimicrobial susceptibility testing were available in eight studies, and sequential therapy was able to eradicate 72.8% (61.6% to 82.8%) of the strains resistant to clarithromycin.

Conclusions: Eradication rates with pre-existing and new therapies for H pylori are suboptimal. Regional monitoring of resistance rates should help to guide treatment, and new agents for treatment need to be developed.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; CS has received consulting fees for advisory committees or review panels from Pfizer, Janssen-Cilag, and Sidem and for speaking and teaching from AstraZeneca; NV has received consulting fees for speaking and teaching from AstraZeneca, Takeda, Ironwood, and Otsuka and has ownership interest (stock shareholder) in Meridian Diagnostics and Orexo; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow diagram of systematic review. ITT=intention to treat; PP=per protocol.
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Fig 2 Forest plot of sequential therapy versus seven day triple therapy
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Fig 3 Forest plot of sequential therapy versus 10 day triple therapy
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Fig 4 Forest plot of sequential therapy versus 14 day triple therapy
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Fig 5 Forest plot of sequential therapy versus bismuth containing therapies
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Fig 6 Forest plot of sequential therapy versus non-bismuth containing quadruple therapy
See this image and copyright information in PMC

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