Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2016; 22(23): 5445-5453
Published online Jun 21, 2016. doi: 10.3748/wjg.v22.i23.5445
Nonbismuth concomitant quadruple therapy for Helicobacter pylori eradication in Chinese regions: A meta-analysis of randomized controlled trials
Lien-Chieh Lin, Tzu-Herng Hsu, Kuang-Wei Huang, Ka-Wai Tam
Lien-Chieh Lin, Tzu-Herng Hsu, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
Kuang-Wei Huang, Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
Ka-Wai Tam, Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
Ka-Wai Tam, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
Ka-Wai Tam, Cochrane Taiwan, Taipei Medical University, Taipei 110, Taiwan
Ka-Wai Tam, Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
Author contributions: Lin LC and Hsu TH contributed equally to this work; Lin LC, Hsu TH and Tam KW acquired, analyzed and interpreted the data, and drafted the article; Tam KW contributed to conception and design of the study; Huang KW critically revised the manuscript; and all authors approved the final version.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ka-Wai Tam, MD, PhD, Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei 23561, Taiwan. kelvintam@h.tmu.edu.tw
Telephone: +886-2-22490088-8860 Fax: +886-2-22490088-2507
Received: March 15, 2016
Peer-review started: March 18, 2016
First decision: March 31, 2016
Revised: April 8, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 21, 2016
Processing time: 89 Days and 17.8 Hours
Abstract

AIM: To evaluate the applicability of nonbismuth concomitant quadruple therapy for Helicobacter pylori (H. pylori) eradication in Chinese regions.

METHODS: A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the efficacy of nonbismuth concomitant quadruple therapy between sequential therapy or triple therapy for H. pylori eradication in Chinese regions. The defined Chinese regions include China, Hong Kong, Taiwan, and Singapore. The primary outcome was the H. pylori eradication rate; the secondary outcome was the compliance with therapy. The PubMed, Embase, Scopus, and Cochrane databases were searched for studies published in the period up to March 2016 with no language restriction.

RESULTS: We reviewed six randomized controlled trials and 1616 patients. In 3 trials comparing concomitant quadruple therapy with triple therapy, the H. pylori eradication rate was significantly higher for 7-d nonbismuth concomitant quadruple therapy than for 7-d triple therapy (91.2% vs 77.9%, risk ratio = 1.17, 95%CI: 1.09-1.25). In 3 trials comparing quadruple therapy with sequential therapy, the eradication rate was not significant between groups (86.9% vs 86.0%). However, higher compliance was achieved with concomitant therapy than with sequential therapy.

CONCLUSION: The H. pylori eradication rate was higher for nonbismuth concomitant quadruple therapy than for triple therapy. Moreover, higher compliance was achieved with nonbismuth concomitant quadruple therapy than with sequential therapy. Thus, nonbismuth concomitant quadruple therapy should be the first-line treatment in Chinese regions.

Keywords: Helicobacter pylori eradication; Nonbismuth concomitant quadruple therapy; Peptic ulcer; Chinese region

Core tip:Helicobacter pylori (H. pylori) infection is highly prevalent in Chinese regions and associated with peptic ulcers. Currently, triple and sequential therapies have been widely used to eradicate H. pylori. Nonbismuth concomitant quadruple therapy is an alternative treatment with high efficacy. Our meta-analysis revealed that a higher H. pylori eradication rate was achieved with 7-d concomitant therapy than with 7-d triple therapy. The eradication rates of concomitant and sequential therapies were similar. However, the compliance with concomitant therapy was higher. Therefore, nonbismuth concomitant quadruple therapy should be the first-line treatment for H. pylori infection.