Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment.

Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Research Abstract Details 

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Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Abstract Text:

BACKGROUND: Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious. PURPOSE: To compare sequential therapy with standard triple therapy for H. pylori infection. DATA SOURCES: MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used. STUDY SELECTION: Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection. DATA EXTRACTION: 3 reviewers independently assessed trial eligibility and quality and extracted data on eradication. DATA SYNTHESIS: The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n = 1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to 77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles. LIMITATIONS: Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias. CONCLUSION: Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.

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Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: Annals of internal medicine

VOLUME: 148

Page Numbers: 923-31

Journal Abbreviation: Ann. Intern. Med.

ISSN: 1539-3704

DAY: 19

MONTH: 05

YEAR: 2008

Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Information

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LANGUAGE: eng

NlmUniqueID: 372351

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AFFILIATION: University of Louisville, Louisville, Kentucky 40202, USA.

Country: United States

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MEDLINETA: Ann Intern Med

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