Randomised controlled trial: sequential vs. standard triple therapy for <scp>H</scp>elicobacter pylori infection in Chinese children–a multicentre, open‐labelled study

Jian, Huang; Zhou, Liya; Geng, Lanlan; Yang, Mingzhe; Xu, Xiping; Ding, Zhaolu; Mao, Meng; Wang, Z.-L.; Li, Z.-L.; Li, D.-Y.; Gong, Sitang

doi:10.1111/apt.12516

Cited by 24 publications

(37 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Standard triple therapy remains the gold standard for eradicating H. pylori ; however, more recent studies have shown a constant decline in H. pylori eradication rates, to as low as 50% 12,23,24. This decline has been attributed to increased clarithromycin resistance and low medication compliance secondary to medication side effects 13,14.…”

Section: Discussionmentioning

confidence: 99%

“…Each probiotic strain has a unique mechanism of action that may be more or less effective in increasing H. pylori eradication and reducing the side effects. Previous studies have shown that probiotics significantly reduce the risk of antibiotic-associated side effects, including nausea, vomiting, diarrhea, and epigastric pain 24,26. These commensal bacteria inhibit enteric pathogens and suppress pathogenic bacterial growth and invasion, ultimately improving intestinal barrier function 28.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Probiotics improve the efficacy of standard triple therapy in the eradication of Helicobacter pylori: a meta-analysis

Lau¹,

Ward²,

Chamberlain³

2016

IDR

View full text Add to dashboard Cite

IntroductionHelicobacter pylori colonization is present in half of the world’s population and can lead to numerous gastrointestinal diseases if left untreated, including peptic ulcer disease and gastric cancer. Although concurrent triple therapy remains the recommended treatment regimen for H. pylori eradication, its success rate and efficacy have been declining. Recent studies have shown that the addition of probiotics can significantly increase eradication rates by up to 50%. This meta-analysis examines the impact of probiotic supplementation on the efficacy of standard triple therapy in eradicating H. pylori.MethodsA comprehensive literature search was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (time of inception to 2016) to identify all published randomized control trials (RCTs) assessing the use of probiotics in addition to triple therapy for the treatment of H. pylori. Searches were conducted using the keywords “probiotics”, “triple therapy”, and “Helicobacter pylori”. RCTs comparing the use of probiotics and standard triple therapy with standard triple therapy alone for any duration in patients of any age diagnosed with H. pylori infection were included. H. pylori eradication rates (detected using urea breath test or stool antigen) were analyzed as-per-protocol (APP) and intention-to-treat (ITT).ResultsA total of 30 RCTs involving 4,302 patients APP and 4,515 patients ITT were analyzed. The addition of probiotics significantly increased eradication rates by 12.2% (relative risk [RR] =1.122; 95% confidence interval [CI], 1.091–1.153; P<0.001) APP and 14.1% (RR =1.141; 95% CI, 1.106–1.175; P<0.001) ITT. Probiotics were beneficial among children and adults, as well as Asians and non-Asians. No significant difference was observed in efficacy between the various types of probiotics. The risk of diarrhea, nausea, vomiting, and epigastric pain was also reduced.ConclusionThe addition of probiotics is associated with improved H. pylori eradication rates in both children and adults, as well as Asians and non-Asians. Lactobacillus, Bifidobacterium, Saccharomyces, and mixtures of probiotics appear beneficial in H. pylori eradication. Furthermore, the reduction in antibiotic-associated side effects such as nausea, vomiting, diarrhea, and epigastric pain improves medication tolerance and patient compliance. Given the consequences associated with chronic H. pylori infection, the addition of probiotics to the concurrent triple therapy regimen should be considered in all patients with H. pylori infection. However, further studies are required to identify the optimal probiotic species and dose.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Probiotics improve the efficacy of standard triple therapy in the eradication of Helicobacter pylori: a meta-analysis

Lau¹,

Ward²,

Chamberlain³

2016

IDR

View full text Add to dashboard Cite

show abstract

“…The aim of the study was to evaluate whether the cure rate of different regimens can achieve above 90%. According to the eradication frequency of triple therapy, sequential therapy, bismuth‐containing quadruple therapy, and concomitant therapy, which was 67.7%, 81.4%, 91.9%, and 91.7%, we estimated a sample size of 48 in each group to give a statistical power of α (0.05) with a loss of follow‐up to 20%.…”

Section: Methodsmentioning

confidence: 99%

“…The initial study by Francavilla et al demonstrated that sequential therapy can achieve a high eradication of 97.3%. Sequential therapy has been reported to be more effective than 7‐day or 10‐day standard triple therapy in many countries, while the eradication rate ranged from 73% to 81.4% . Bismuth quadruple therapy (BQT) refers to a combination of PPI, bismuth, and two antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

View full text Add to dashboard Cite

Backgrounds Due to the decreasing eradication rate of Helicobacter pylori, some novel alternatives have been developed, such as bismuth‐containing quadruple therapy and non‐bismuth‐containing quadruple therapy (sequential and concomitant treatment). Little is known about whether a success rate above 90% can be achieved with these regimens in Chinese children. Methods In this prospective, open, comparative cross‐sectional study, we recruited treatment‐naïve children (aged between 6 and 18 years) with H pylori infection. The patients were assigned either standard triple therapy, sequential therapy, bismuth‐based quadruple therapy, or concomitant therapy at the discretion of the prescribing physician. H pylori infection was evaluated at least 4 weeks after the completion of the treatment. A negative urea breath test (UBT) indicated successful eradication. The primary endpoint was the eradication frequency of H pylori in the full analysis set (FAS), which included all children who received at least one dose of the treatment and with available follow‐up data. Results Between September 2017 and December 2018, 228 patients were finally included in the FAS analyses. The eradication rates were 74.1% for standard triple therapy (43/58, [95% CI: 62.8%‐85.5%]), 69.5% for sequential therapy (41/59, [95% CI: 57.8%‐81.2%]), 89.8% for bismuth‐based quadruple therapy (53/59, [95% CI: 82.1%‐97.5%]), and 84.6% for concomitant therapy (44/52, [95% CI: 74.8%‐94.4%]). Bismuth‐based therapy was superior to triple therapy, while sequential therapy and concomitant therapy were not superior to triple therapy. The frequency of adverse events was 12.1% (7/58) in standard triple therapy, 6.8% (4/59) in sequential therapy, 15.3% (9/59) in bismuth‐based therapy, and 15.4% (8/52) in concomitant therapy. The rate of adverse events was similar among the four groups. Conclusion Bismuth quadruple therapy can achieve an eradication rate of 89.8% as first‐line treatment and is safe and well tolerated. Bismuth could be a promising alternative as a first‐line regimen in Chinese children.

show abstract

“…In some articles, the results of 10 day sequential therapy and standard triple therapy were assessed . Huang et al.…”

Section: Diagnosismentioning

confidence: 99%

Helicobacter pylori Infection in Pediatrics

Iwańczak

Francavailla

2014

Helicobacter

View full text Add to dashboard Cite

This review concerns important pediatric studies published from April 2013 to March 2014. New data on pathogenesis have demonstrated that Th1 type cytokine secretion at the gastric level is less intense in children compared with adults. They have also shown that the most significant risk factor for Helicobacter pylori infection is the parents' origin and frequency of childcare in settings with a high prevalence of infection. A new hypothesis on the positive relationship between childhood H. pylori infection and the risk of gastric cancer in adults has been suggested which calls for an implementation of preventive programs to reduce the burden of childhood H. pylori infection in endemic areas. Several studies have investigated the role of H. pylori infection in iron-deficiency anemia, and results support the role of the bacterium in this condition. Antibiotic resistance is an area of intense research with data confirming an increase in antibiotic resistance, and the effect of CYP2C19 genetic polymorphism on proton-pump inhibitor metabolism should be further investigated as cure rates are lower in extensive metabolizers. Studies confirmed that probiotic supplementation may have beneficial effects on eradication and therapy-related side effects, particularly diarrhea in children. PathophysiologyIn numerous studies, the influence of Helicobacter pylori virulence on the development of various diseases has been studied. Alvarez et al. [1,2] studied methylation of some genes predisposing to gastric cancer. They observed that THBS1 and GATA-4 were methylated already in the early stage of infection and are downregulated. HIC-1 demonstrated the lowest level of methylation and therefore, the main mechanism of downregulation has to be different. On the other hand, methylation of promotor regions of MGMT and MLH 1 depended on the duration of the infection. Nodular gastritis was very frequently associated with H. pylori infection in childhood. Nodular gastritis associated with H. pylori infection can commonly occur in childhood and is regarded as benign with no clinical significance. Yang et al. [3] analyzed gastric mucosa-associated lymphoid tissue (MALT) to clarify the significance of nodular gastritis in 80 H. pylori-infected children; histopathologic grading of MALT and immunohistochemistry were evaluated by CD3, CD20, cytokeratin, and Ki-67. On endoscopy, severe nodular gastritis was observed in 47% of the cases and mild gastritis in 34%; gastritis was absent in 19%. Density of H. pylori and lymphocyte infiltration differed among the 3 groups (p = .022 and .025, respectively) and histologic grading for gastric lymphoid infiltrates was compatible, with grade 1 in 59%, grade 2 in 26%, grade 3 in 9%, and grade 4-5 in 5%. The degree of nodular gastritis, density of H. pylori, neutrophil activity, and gastritis score in the antrum varied with MALT grades (p = .003, p = .042, p = .028, and p = .006, respectively). This study suggests that nodular gastritis may present as a significant gastric manifestation and that tho...

show abstract

Randomised controlled trial: sequential vs. standard triple therapy for Helicobacter pylori infection in Chinese children–a multicentre, open‐labelled study

Abstract: SUMMARY BackgroundStudies have showed that 10-day sequential treatment regimen achieved higher Helicobacter pylori eradication rate than standard triple therapies.

Cited by 24 publications

References 31 publications

Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Helicobacter pylori Infection in Pediatrics

Contact Info

Product

Resources

About