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©2010 Baishideng.
World J Gastroenterol. Aug 21, 2010; 16(31): 3865-3870
Published online Aug 21, 2010. doi: 10.3748/wjg.v16.i31.3865
Published online Aug 21, 2010. doi: 10.3748/wjg.v16.i31.3865
Topics of meta-analysis | No. of studies |
First-line triple therapies | 25 |
PPI-based therapies | 22 |
Ranitidine bismuth citrate-based therapies | 3 |
Bismuth-based quadruple therapies | 2 |
Non-bismuth-based quadruple therapies | 1 |
Histamine H2 receptor blockers + two different antibiotics | 5 |
Rescue (second- and third-line) therapies | 3 |
Sequential therapies | 4 |
Alternative therapies | 4 |
Eradication in functional dyspepsia | 20 |
Eradication in peptic ulcer | 10 |
Effect of CagA status on eradication | 1 |
Gastric cancer prevention | 5 |
Eradication in children | 2 |
Eradication in prevention of NSAID-ulcers | 1 |
Eradication in extradigestive diseases | 5 |
Effect of probiotics on eradication results | 5 |
Eradication and antimicrobial resistance | 4 |
Effect of CYP polymorphism on eradication | 2 |
Adverse effects of eradication | 4 |
Multiple topics | 11 |
Total | 113 |
Author | Databases, abstracts1 | Study period | No. of studies | No. of patients | Eradication rate [ITT, (%) mean + 95% CI] | Duration of treatment (d) | Comments |
Bazzoli et al[11] | Medline | 1993-1996 | 14 | 507 | LAC: 80.6 | 7 | L and O are equally efficient |
OAC: 69.6 | |||||||
Laheij et al[12] | Medline, abstracts | 1983-1998 | 644 | 53 228 | PPI + A + C: 80.09 (NS) | 7-14 | |
Huang et al[13] | Medline, PubMed, abstracts | 1986-1998 | 82 | 6123 | PPI + A + C: 89.5.6 (86.9-92.0) | 7 | C 500 mg b.i.d. achieved the best result |
PPI + A + M: 90.8% (87.0-94.5) | |||||||
Gisbert et al[14] | PubMed | 1986-1999 | 22 | 2862 | PPI + A + C: 81 (76-85) | 7 | PAC and PAN have similar efficiency |
PPI + A + N: 84 (79-89) | |||||||
Gisbert et al[15] | PubMed + abstracts | 1995-1999 | 12 | 1170 | RBC + A + C: 76.6 (72-81) | 7 | RBC + AC and PPI + AC have similar efficiency, RBC + CN has higher efficiency than PPI + CN |
RBC + CN: 87.2 (83-91) | |||||||
PPIAC: 73.7 (69-78) | |||||||
PPIAN: 74.9 (71-84) | |||||||
Calvet et al[16] | Medline + abstracts | 1990-1999 | 21 | 1349 | PPI + 2AB | Triple therapies of 14 d are superior to 7, but not 10 d regimens | |
76 (68-86) | 7 | ||||||
82 (77-86) | 10 | ||||||
84 (79-8) | 14 | ||||||
Janssen et al[17] | Medline + abstracts | 1994-2000 | 47 | 3541 | RBC + A + C: 81 (71-96) | 5-10 | PPI + AC and NC are equally effective, RBCNC is superior to RBCAC |
RBC + N + C: 88 (78-94) | |||||||
PPI + A + C: 79 (24-95) | |||||||
PPI + N + C: 79 (42-100) | |||||||
Vallve et al[18] | Medline + abstract | 1996-2000 | 13 | 2391 | Single dose PPI: 77.7 (72-77) | 7 | Single dose PPI triple regimens are less efficient |
Double dose PPI: 83.9 (81-85) | |||||||
Vergara et al[19] | Medline + abstracts | 1995-2002 | 134 | 3293 | O: 74.7 (NS) | 7 | PPIs are similar in standard triple therapy |
L: 74.7 (NS) | |||||||
R: 77.9 (NS) | |||||||
E: 87.9 (NS) | |||||||
Gené et al[20] | PubMed, abstracts | 1995-2002 | 5 | 1118 | Triple therapy: 79 (74-81) | 7-10 | The effectiveness of triple and quadruple therapies is similar |
Quadruple therapy: 80 (77-84) | |||||||
Gisbert et al[21] | Medline, Embase, CINAHL, CCTR | 1996-2002 | 7 | 2226 | RAC: 79 (76-82) | 7-14 | R, O and L achieved similar results |
OAC: 77 (74-80) | |||||||
LAC: 77 (75-79) | |||||||
Gisbert et al[22] | Medline, congress abstracts | 1997-2003 | 12 | 1137 | P + 2AB: 83 (78-88) | 7 | P, O and L achieved similar results |
O, L + 2AB: 81 (77-86) | |||||||
Gisbert et al[23] | Medline, congress abstracts | 1999-2003 | 4 | 816 | E + 2AB: 85 (81-89) | 7 | E + 2AB has comparable efficacy with O + 2AB |
O + 2AB: 82 (78-86) | |||||||
Gisbert et al[24] | Medline, Embase, CINAHLISIWS + congress abstracts | 1997-2004 | 14 | 4435 | RBC + C + A: 79.5 (72.2-83.7) | 7-10-14 | RBC or PPI + A + C are comparable, RBC + C + N is superior to PPI + C + N |
PPI + C + A: 78.1 (73.6-84.1) | 7-10-14 | ||||||
RBC + C + N: 87.4 (82.8-93.6) | 7-10-14 | ||||||
PPI + C + N: 79.9 (73.6-84.8) | 7-10-14 | ||||||
Padol et al[25] | Medline, Embase, CCTR | 1996-2005 | 17 | 1569 | PPI + 2AB | 7-14 | O, but not L and R effect is influenced by CYP2C19 status |
PM: 88.9 (81.2-97.6) | |||||||
HomEM: 70.9 (64.3-77.4) | |||||||
HetEM: 82.7 (75.3-89.2) | |||||||
Suzuki et al[26] | PubMed | 1998-2005 | 14 | 1529 | CagA +: 84% (79-89%) | 7-14 | Presence of CagA is predictive for a successful eradication |
CagA-: 73% (65-82) | |||||||
Wang et al[27] | Medline, Embase, CCTR | 2000-2005 | 11 | 2159 | E + 2AB: 86% | 7 | E, O and P are of comparable efficiency |
PPI + 2AB: 81% | |||||||
Buzás et al[28] | Abstracts | 1997-2004 | 75 | 15 634 | PPI + 2AB: 81.4% (78.5-84.5) | 7 | PPIs, RBC + 2AB and quadruple regimens are equally efficient as first-line therapies |
RBC + 2AB: 78.5% (70.5-84.3) | |||||||
PPI + 2AB + bismuth: 82.6% (76.0-89.2) | |||||||
Fuccio et al[29] | Medline, Embase, CCTR, abstracts | 1996-2007 | 21 | 4831 | PPI + 2AB: | Extending triple therapy to 10-14 d is not useful | |
75% (72-77) | 7 | ||||||
80.7% (75.2-85.7) | 10 | ||||||
78.2% (74.3-82.6) | 14 | ||||||
Villoria et al[30] | PubMed, ISIWS, Embase, CCTR CINAH, abstracts | 1990-2007 | 6 | 1703 | High-dose PPI: 82% (78-84) | 7 | High-dose PPIs are 8% more effective than standard doses in 7 d therapies |
Standard dose PPI: 74% (NS) | |||||||
Zhao et al[31] | Medline, PubMed, Embase, ISIWB, CCTR, Chinese Databases | 1999-2007 | 20 | 3330 | PMs: 91.6 (83-99) | 7-10-14 | O and L effects are dependent on CYP2C19 genotype, R effect is not dependent |
HetEMs: 85.5 (79.6-92.3) | |||||||
HomEMs: 74.6 (70.1-79.8) | |||||||
Essa et al[32] | PubMed, Embase, CCTR + abstracts | 1990-2008 | 9 | 1054 | Triple therapies: 76.8 (72.2-81.2) | 5-10 | Concomitant quadruple therapy is superior to standard triple therapy |
Concomitant quadruple therapy: 89.7% (86.8-92.1) | 7 | ||||||
Luther et al[33] | Medline, Embase, Google Scholar, CCTR, ACP Journal Club | 1996-2009 | 9 | 1679 | PPI + AC: 77.0 (71-84) | 7 | Triple and quadruple therapies yielded similar suboptimal results |
PPI + 2AB + | |||||||
Bi: 78.3 (71.7-84.6) |
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Citation: Buzás GM. First-line eradication of
Helicobacter pylori : Are the standard triple therapies obsolete? A different perspective. World J Gastroenterol 2010; 16(31): 3865-3870 - URL: https://www.wjgnet.com/1007-9327/full/v16/i31/3865.htm
- DOI: https://dx.doi.org/10.3748/wjg.v16.i31.3865