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Eradication rates for Helicobacter pylori infection a systematic evidence - based review

  • Metaanalysis
  • Published:
Hellenic Journal of Surgery

Abstract

Aim

The aim of this study is to summarize all available published studies regarding pharmacologic management of newly onset and recurrent peptic ulcers, provide a critical insight into indistinguishable features of H. pylori, and construct a useful clinical tool for decision making.

Methods

A thorough search was performed of electronic databases including MEDLINE, Embase, Pubmed, Scopus and Cochrane Library from 1990 up to 2014. A systematic review and meta-analysis was to be carried out, pooling the effects of outcomes of patients and lesions enrolled in the studies.

Results

The primary end-points of this thesis will be the construction of a pharmacological management algorithm of H. Pylori eradication in various disease states. In uncomplicated peptic ulcer, first line eradication therapy of H. pylori should include one of the following: triple [(PPI, clarithromycin, amoxicillin)-(PPI, clarithromycin, metronidazole)]/ quadruple (PPI, clarithromycin, amoxicillin, nitroimidazole)/Bismuth-containing (ranitidine, Bismuth subsalicylate, metronidazole, tetracycline) for 10-14 days or sequential for five days (PPI+amoxicillin) plus five days (PPI, clarithromycin, tinidazole). If the first line H. pylori eradication regimen is unsuccessful, second line H. pylori eradication regimens should comprise one of the following: Bismuth based/triple (levofloxacin substitutes clarithromycin). In cases of clarithromycin resistance, H. pylori eradication regimens should include one of the following: Bismuth-based /quadruple/sequential (levofloxacin substitutes clarithromycin). In cases of metronidazole resistance, H. pylori eradication regimens should incorporate one of the following: triple/ sequential (levofloxacin substitutes clarithromycin). In cases of clarithromycin and metronidazole resistance H. pylori eradication regimens should include the following: sequential (levofloxacin substitutes clarithromycin).

Conclusion

Though there is sufficient evidence to safeguard Grade A recommendations for H. pylori eradication regimens in cases of first- and second-line treatments, resistance and peptic ulcer complications, high-quality randomized controlled trials that will include distinct ethnic groups, homogeneous endoscopic diagnosis and treatment, double-blind designs, and evaluation of outcomes operating specific criteria over set follow-up periods are lacking.

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Abbreviations

NSAIDS:

Non-steroidal anti-inflammatory drugs

PPI:

Proton pump inhibitor

H2-blockers:

Histamine 2 receptor blockers

RCT:

Randomized controlled trials

ITT:

Intention to treat

OR:

Odds Ratio

RR:

Risk Ratio

95%CI:

95% confidence interval

FE:

Fixed effects model

RE:

Random effects model

RBC:

Ranitidine bismuth citrate

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Authors and Affiliations

  1. 2nd Surgical Department and Surgical Oncology Unit, “Korgialenio-Benakio” Red Cross Hospital, Athens, Greece

    G. Sgourakis, A. Pindireki, A. Kouloura, G. Sourtse, V. Ganis, S. Peristeraki, K. Karkoulias, S. Georgopoulos & S. Lanitis

  2. Reumatology, Physical Medicine and Rehabilitation Clinic of VFN, University Hospital, Prague, Czech Republic

    Ch. Karaliotas

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  1. G. Sgourakis
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Correspondence to G. Sgourakis.

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Sgourakis, G., Pindireki, A., Kouloura, A. et al. Eradication rates for Helicobacter pylori infection a systematic evidence - based review. Hellenic J Surg 87, 377–386 (2015). https://doi.org/10.1007/s13126-015-0244-z

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  • DOI: https://doi.org/10.1007/s13126-015-0244-z

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