The Contribution of Meta-Analyses to the Treatment of Helicobacter pylori

After 30 years of experience in Helicobacter pylori treatment, however, the ideal regimen to treat this infection has still to be found. Systematic reviews and metaanalyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The aim of this chapter is to review published meta-analyses focused on H. pylori eradication treatments. Initially, dual therapies containing one antibiotic combined with bismuth compounds or proton pump inhibitors (PPIs) obtained sub-optimal cure rates. The most recommended therapies have been triple therapies containing a PPI and two antibiotics. PPI-based regimens are more effective than H2-antagonists-based ones. Bismuth-containing quadruple therapy is roughly equivalent to triple therapy in terms of effectiveness, compliance and safety profile. The influence of the type of PPI, the dosage and the length of treatment have been discussed. Clarithromycin and metronidazole antibiotic resistance are the most relevant factors causing eradication failure. As a progressive decrease in the eradication rate after standard triple therapy has been reported, more recently, sequential and nonbismuth quadruple (concomitant) therapies have been recommended in settings where the efficacy of triple therapy is unacceptably low. The role of prebiotics and probiotics as adjunctive treatment for H. pylori infection has also been reviewed. Several rescue options have been proposed. Bismuth-based quadruple therapy is effective, but its complexity and the associated adverse effects affect compliance. PPI plus amoxicillin combined with levofloxacin or moxifloxacin is at least as effective, and better tolerated.

Keywords: Helicobacter pylori, meta-analysis, proton pump inhibitor, bismuth, ranitidine bismuth citrate, clarithromycin, amoxicillin, levofloxacin, treatment, therapy, omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, sequential therapy, concomitant therapy, resistance.