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.
Similar content being viewed by others
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
References
Marshall BJ, Warren JR. Unidenti fied curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311–5.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996;20:1161–81.
Ciociola AA, McSorley DJ, Turner K, Sykes D, Palmer JB. Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol 1999;94:1834–40.
Eslick GD, Lim LL, Byles JE, Xia HH, Talley NJ. Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis. Am J Gastroenterol 1999;94:2373–9.
Zucca E, Bertoni F, Roggero E, et al. Molecular analysis of the progression from Helicobacter pylori-associated chronic gastritis to mucosa-associated lymphoid-tissue lymphoma of the stomach. N Engl J Med 1998;338:804–10.
Fuccio L, Zagari RM, Eusebi LH, et al. Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med 2009;151:121–8.
Gisbert JP, Gonzalez L, Calvet X, et al. Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: a meta-analysis of eradication of Helicobacter pylori. Aliment Pharmacol Ther 2000;14:1319–28.
Laine L, Fennerty MB, Osato M, et al. Esomeprazole-based Helicobacter pylori eradication therapy and the effect of antibiotic resistance: results of three US multicenter, doubleblind trials. Am J Gastroenterol 2000;95:3393–8.
Gatta L, Zullo A, Perna F, et al. A 10-day levofloxacin-based triple therapy in patients who have failed two eradication courses. Aliment Pharmacol Ther 2005;22:45–9.
Gisbert JP, Gonzalez L, Calvet X. Systematic review and meta-analysis: proton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics in Helicobacter pylori eradication. Helicobacter 2005;10:157–71.
Qasim A, Sebastian S, Thornton O, et al. Rifabutin-and furazolidone-based Helicobacter pylori eradication therapies after failure of standard first-and second-line eradication attempts in dyspepsia patients. Aliment Pharmacol Ther 2005;21:91–6.
Malfertheiner P, Megraud F, O'M orain CA, et al. Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report. Gut 2012;61:646–64
Vallve M, Vergara M, Gisbert JP, Calvet X. Single vs. double dose of a proton pump inhibitor in triple therapy for Helicobacter pylori eradication: a meta-analysis. Aliment Pharmacol Ther 2002;16:1149–56.
Gisbert JP, Khorrami S, Calvet X, Pajares JM. Systematic review: Rabeprazole-based therapies in Helicobacter pylori eradication. Aliment Pharmacol Ther 2003;17:751–64.
Bazzoli F, Pozzato P, Zagari M, et al. Efficacy of lansoprazole in eradicating Helicobacter pylori: a meta-analysis. Helicobacter 1998;3:195–201.
Gisbert JP, Khorrami S, Calvet X, Pajares JM. Pantoprazole based therapies in Helicobacter pylori eradication: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2004;16:89–99.
Wang X, Fang JY, Lu R, Sun DF. A meta-analysis: comparison of esomeprazole and other proton pump inhibitors in eradicating Helicobacter pylori. Digestion 2006;73:178–86.
Gisbert JP, Pajares JM. Esomepr azole-based therapy in Helicobacter pylori eradication: a meta-analysis. Dig Liver Dis 2004;36:253–9.
Vergara M, Vallve M, Gisbert JP, Calvet X. Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther 2003;18:647–54.
Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007;147:553–62.
Vakil N, Connor J. Helicobacter pylori eradication: equivalence trials and the optimal duration of therapy. Am J Gastroenterol 2005;100:1702–3.
Fischbach L, Evans EL. Meta-ana lysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple firstline therapies for Helicobacter pylori. Aliment Pharmacol Ther 2007;26:343–57.
Gatta L, Vakil N, Vaira D, Scar pignato C. Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy. BMJ. 2013 Aug 7;347:f4587. doi: 10.1136/bmj.f4587.
Romano M, Cuomo A, Gravina AG, et al. Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial. Gut 2010;59:1465–1470.
Janssen MJ, Van Oijen AH, Verbeek AL, Jansen JB, De Boer WA. A systematic comparison of triple therapies for treatment of Helicobacter pylori infection with proton pump inhibitor/ ranitidine bismuth citrate plus clarithromycin and either amoxicillin or a nitroimidazole. Aliment Pharmacol Ther 2001;15:613–24.
Gisbert JP, Gonzalez L, Calvet X, Roque M, Gabriel R, Pajares JM. Helicobacter pylori eradication: proton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics for 1 week-a meta-analysis of efficacy. Aliment Pharmacol Ther 2000;14:1141–50.
Drlica K, Zhao X. DNA gyrase, t opoisomerase IV, and the 4-quinolones. Microbiol Mol Biol Rev 1997;61:377–92.
Li Y, Huang X, Yao L, Shi R, Zhang G. Advantages of Moxifloxacin and Levofloxacin-based triple therapy for secondline treatments of persistent Helicobacter pylori infection: a meta analysis. Wien Klin Wochenschr. 2010;122:413–22.
Saad RJ, Schoenfeld P, Kim HM, Chey WD. Levofloxacinbased triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis. Am J Gastroenterol 2006;101:488–96.
Gisbert JP, Morena F. Systemati c review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther 2006;23:35–44.
Wenzhen Y, Kehu Y, Bin M, et al. Moxifloxacin-based triple therapy versus clarithromycin-based triple therapy for first-line treatment of Helicobacter pylori infection: a meta-analysis of randomized controlled trials. Intern Med 2009;48:2069–76.
Chey WD, Wong BC. American Coll ege of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007;102:1808–25.
Fischbach LA, van Zanten S, Dic kason J. Meta-analysis: the efficacy, adverse events, and adherence related to firstline anti-Helicobacter pylori quadruple therapies. Aliment Pharmacol Ther 2004;20:1071–82.
de Boer WA, Tytgat GN. The best therapy for Helicobacter pylori infection: should efficacy or side-effect profile determine our choice? Scand J Gastroenterol 1995;30:401–7.
Kwok CS, Arthur AK, Anibueze CI, Singh S, Cavallazzi R, Loke YK. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107:1011–19.
Eom CS, Jeon CY, Lim JW, Cho EG, Park SM, Lee KS. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011;183:310–19.
Yu EW, Bauer SR, Bain PA, Bauer DC. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011;124:519–26.
Chow DK, Sung JJ. Is the preval ence of idiopathic ulcers really on the increase? Nat Clin Pract Gastroenterol Hepatol 2007;4:176–7.
Laine L, Hopkins RJ, Girardi LS. Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta-analysis of rigorously designed trials. Am J Gastroenterol 1998;93:1409–15.
Hung LC, Ching JY, Sung JJ, et al. Long-term outcome of Helicobacter pylori-negative idiopathic bleeding ulcers: a prospective cohort study. Gastroenterology 2005;128:1845–50.
Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol 2006;101:848–63.
Bytzer P, Teglbjaerg PS. Helico bacter pylori-negative duodenal ulcers: prevalence, clinical characteristics, and prognosis—results from a randomized trial with 2-year follow-up. Am J Gastroenterol 2001;96:1409–16.
Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis 2004;10:646–51.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13126-015-0244-z