Pharmacological regimens for eradication of Helicobacter pylori: an overview of systematic reviews and network meta-analysis

Abstract

BackgroundApproximately half of the world’s population is infected with Helicobacter pylori (H.pylori), a bacterium shown to be linked with a series of gastrointestinal diseases. A growing number of systematic reviews (SRs) have been published comparing the effectiveness of different treatments for H.pylori infection but have not reached a consistent conclusion. The objective of this study is to provide an overview of SRs of pharmacological therapies for the eradication of H.pylori.MethodsMajor electronic databases were searched to identify relevant SRs published between 2002 and February 2016. Studies were considered eligible if they included RCTs comparing different pharmacological regimens for treating patients diagnosed as H.pylori infected and pooled the eradication rates in a meta-analysis. A modified version of the ‘A Measurement Tool to Assess Systematic Reviews’ (AMSTAR) was used to assess the methodological quality. A Bayesian random effects network meta-analysis (NMA) was conducted to compare the different proton pump inhibitors (PPI) within triple therapy.Results30 SRs with pairwise meta-analysis were included. In triple therapy, the NMA ranked the esomeprazole to be the most effective PPI, followed by rabeprazole, while no difference was observed among the three old generations of PPI for the eradication of H.pylori. When comparing triple and bismuth-based therapy, the relative effectiveness appeared to be dependent on the choice of antibiotics within the triple therapy; moxifloxacin or levofloxacin-based triple therapy were both associated with greater effectiveness than bismuth-based therapy as a second-line treatment, while bismuth-based therapy achieved similar or greater eradication rate compared to clarithromycin-based therapy. Inconsistent findings were reported regarding the use of levofloxacin/moxifloxacin in the first-line treatment; this could be due to the varied resistant rate to different antibiotics across regions and populations. Critical appraisal showed a low-moderate level of overall methodological quality of included studies.ConclusionsOur analysis suggests that the new generation of PPIs and use of moxifloxacin or levofloxacin within triple therapy as second-line treatment were associated with greater effectiveness. Given the varied antibiotic resistant rate across regions, the appropriateness of pooling results together in meta-analysis should be carefully considered and the recommendation of the choice of antibiotics should be localized.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0491-7) contains supplementary material, which is available to authorized users.

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

“…The eradication rate (96.9%, ITT analysis) obtained by treatment with Pylera® in the present series of patients from Southern Italy was higher than that reported by previous international studies [12,51,55], but similar to that reported by another recent Italian study both in patients on first treatment and in rescue therapy [56], confirming the elevated therapeutic efficacy of regimen with bismuth subcitrate potassium in this specific geographical area.…”

“…Alternative second-line (i.e. when first-line therapy fails) therapeutic approaches contain PPI plus amoxicillin plus levofloxacin [12]. More recently, a combination of tetracycline hydrochloride, metronidazole, and bismuth subcitrate potassium (Pylera®) has been developed as either the first-and second-line regimen [5,8,13].…”

Vonoprazan, a Novel Potassium-Competitive Acid Blocker, Should Be Used for the Helicobacter pylori Eradication Therapy as First Choice: A Large Sample Study of Vonoprazan in Real World Compared with Our Randomized Control Trial Using Second-Generation Proton Pump Inhibitors for Helicobacter pylori Eradication Therapy

“…It was thus considered possible for us to compare vonoprazan-based therapy with PPI-based therapy after eliminating CAM-resistant organism ratios on H. pylori eradication therapy. Xin et al [39] performed a meta-analysis of H. pylori eradication therapies using 5 PPIs and ranked PPIs in the order of effects. The top 2 PPIs were the second-generation PPIs EPZ and RPZ, which indicated that second-generation PPIs are more effective than first-generation PPIs in H. pylori eradication therapy.…”

Systematic reviews and meta-analyses on psoriasis: role of funding sources, conflict of interest and bibliometric indices as predictors of methodological quality

“…The AMSTAR tool has been used previously in > 170 methodological quality-assessment articles in other fields of research, including cardiology, 28,29 gastroenterology, 30 gynaecology, [31][32][33][34] neumology, 35,36 neurology, 37-39 neurosurgery, [40][41][42] general surgery, 43,44 urology, 45,46 radiology 47 and odontology. 48 Most studies achieved similar general conclusions to our study.…”