scholarly journals Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis

Gut ◽  
2022 ◽  
pp. gutjnl-2021-326583
Author(s):  
Alexander C Ford ◽  
Evangelos Tsipotis ◽  
Yuhong Yuan ◽  
Grigorios I Leontiadis ◽  
Paul Moayyedi
Keyword(s):  
Helicobacter Pylori ◽  
Adverse Events ◽  
Functional Dyspepsia ◽  
Meta Analysis ◽  
Pearson Correlation ◽  
Cochrane Review ◽  
Eradication Therapy ◽  
Number Needed To Treat ◽  
H Pylori ◽  
Randomised Controlled

ObjectiveFunctional dyspepsia (FD) is a chronic disorder that is difficult to treat. Helicobacter pylori may contribute to its pathophysiology. A Cochrane review from 2006 suggested that eradication therapy was beneficial, but there have been numerous randomised controlled trials (RCTs) published since. We evaluated impact of eradication therapy on both cure and improvement of FD, as well as whether any benefit was likely to arise from eradication of H. pylori.DesignWe searched the medical literature through October 2021 to identify RCTs examining efficacy of eradication therapy in H. pylori-positive adults with FD. The control arm received antisecretory therapy or prokinetics, with or without placebo antibiotics, or placebo alone. Follow-up was for ≥3 months. We pooled dichotomous data to obtain a relative risk (RR) of symptoms not being cured or symptoms not improving with a 95% CI. We estimated the number needed to treat (NNT).ResultsTwenty-nine RCTs recruited 6781 H. pylori-positive patients with FD. Eradication therapy was superior to control for symptom cure (RR of symptoms not being cured=0.91; 95% CI 0.88 to 0.94, NNT=14; 95% CI 11 to 21) and improvement (RR of symptoms not improving=0.84; 95% CI 0.78 to 0.91, NNT=9; 95% CI 7 to 17). There was no significant correlation between eradication rate and RR of FD improving or being cured (Pearson correlation coefficient=−0.23, p=0.907), but the effect was larger in patients with successful eradication of H. pylori than with unsuccessful eradication (RR=0.65; 95% CI 0.52 to 0.82, NNT=4.5, 95% CI 3 to 9). Adverse events (RR=2.19; 95% 1.10 to 4.37) and adverse events leading to withdrawal (RR=2.60; 95% CI 1.47 to 4.58) were more common with eradication therapy.ConclusionThere is high quality evidence to suggest that H. pylori eradication therapy leads to both cure and improvement in FD symptoms, although the benefit is modest.

scholarly journals Helicobacter pylori Eradication Therapy for Functional Dyspepsia: A Meta-Analysis by Region and H. pylori Prevalence

2019 ◽  
Vol 8 (9) ◽  
pp. 1324 ◽  
Author(s):  
Seung Joo Kang ◽  
Boram Park ◽  
Cheol Min Shin
Keyword(s):  
Helicobacter Pylori ◽  
Functional Dyspepsia ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Cochrane Library ◽  
Control Group ◽  
Number Needed To Treat ◽  
Helicobacter Pylori Eradication ◽  
Dyspeptic Symptoms ◽  
H Pylori

Background: Previous studies on the effect of Helicobacter pylori eradication on functional dyspepsia (FD) are conflicting. We performed a comprehensive meta-analysis on this issue according to region and prevalence of H. pylori. Methods: Randomized controlled trials (RCTs) evaluating the effect of eradication of H. pylori on functional dyspepsia up to December 2018 were searched through PubMed, EMBASE, and the Cochrane Library. Subgroup analyses by the outcome measure, region, and prevalence of H. pylori were performed. All data were analyzed with Review Manager 5.3. Results: Eighteen RCTs were included in our meta-analysis. Overall, the H. pylori eradication group showed significant improvement of symptoms compared with the control group (risk ratio (RR) = 1.18; 95% confidence interval (CI): 1.07–1.30, p < 0.01). There was moderate heterogeneity among studies (I2 = 34%) and the number needed to treat (NNT) was 15.0. Helicobacter pylori eradication improved dyspeptic symptoms both in low (<50%) and high (≥50%) H. pylori prevalence regions (RR = 1.21 and 1.17; 95% CI: 1.02–1.44 and 1.06–1.29, I2 = 49% and 5%, respectively.) In the analysis of studies from Asia, however, the effect of eradication on improvement of dyspepsia was not significant (RR = 1.14; 95% CI: 0.99–1.33, p = 0.08, I2 = 37%). Conclusion: Overall, H. pylori eradication provides significant improvement of symptoms in functional dyspepsia patients regardless of H. pylori prevalence. However, in the analysis of studies from Asia, the eradication did not significantly improve dyspeptic symptoms. In this region, eradication for dyspepsia can be individualized.

scholarly journals Endoscopic Reflux Esophagitis and Reflux-Related Symptoms after Helicobacter pylori Eradication Therapy: Meta-Analysis

2020 ◽  
Vol 9 (9) ◽  
pp. 3007 ◽  
Author(s):  
Mitsushige Sugimoto ◽  
Masaki Murata ◽  
Hitomi Mizuno ◽  
Eri Iwata ◽  
Naoyoshi Nagata ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Reflux Esophagitis ◽  
Reflux Disease ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Case Group ◽  
Inclusion Criteria ◽  
Helicobacter Pylori Eradication ◽  
Significant Difference ◽  
H Pylori

Backgrounds: The etiology of gastroesophageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease is multifactorial and a recent meta-analysis showed no association between the development of GERD and Helicobacter pylori eradication in both Western and East-Asian populations. However, the problem remains that various inclusion criteria are used in these studies, which hinders meta-analysis. With a focus on reflux esophagitis with endoscopic mucosal injury, we meta-analysed to evaluate the association between eradication and reflux esophagitis and symptoms using a clearly defined set of inclusion criteria. Methods: We conducted a meta-analysis of studies published up until March 2020, which compared the incidence of reflux esophagitis and symptoms between patients undergoing H. pylori eradication therapy in a randomized placebo-controlled trial (Category A); between patients with successful and failed eradication (Category B); and between patients with successful vs. failed eradication, receipt of placebo, or no-treatment H. pylori-positives (Category C). Results: A total of 27 studies were included. Significant statistical effects were found for development of endoscopic reflux esophagitis [relative risk (RR): 1.46, 95% confidence interval (CI): 1.16–1.84, p = 0.01] or de novo reflux esophagitis (RR: 1.42, 95% CI: 1.01–2.00, p = 0.03) in the case group that received eradication in all studies, especially in Western populations. There was no significant difference in the incidence of symptoms after eradication between patient and control groups, regardless of category, location of population, or baseline disease. Conclusions: Eradication therapy for H pylori increases the risk of reflux esophagitis, irrespective of past history of esophagitis. In contrast, no effect was seen on reflux-related symptoms.

scholarly journals Efficacy of second-line regimens for Helicobacter pylori eradication treatment: a systemic review and network meta-analysis

2020 ◽  
Vol 7 (1) ◽  
pp. e000472 ◽  
Author(s):  
Yen-Lin Chang ◽  
Yu-Chun Tung ◽  
Yu-Kang Tu ◽  
Hong-Zen Yeh ◽  
Jyh-Chin Yang ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Second Line ◽  
First Line ◽  
Quadruple Therapy ◽  
Clarithromycin Resistance ◽  
H Pylori

BackgroundCurrent guidelines recommend bismuth-containing quadruple therapy (BQT) and quinolone-containing therapy after failure of first-line Helicobacter pylori eradication therapy. However, the optimum regimen of second-line eradication therapy remains elusive. We conducted a network meta-analysis to compare the relative efficacy of 16 second-line H. pylori eradication regimens.MethodsThree major bibliographic databases were reviewed to enrol relevant randomised controlled trials between January 2000 and September 2018. Network meta-analysis was conducted by STATA software and we performed subgroup analysis in countries with high clarithromycin resistance and high levofloxacin resistance, and in patients with documented failure of first-line triple therapy.ResultsFifty-four studies totalling 8752 participants who received 16 regimens were eligible for analysis. Compared with a 7-day BQT, use of probiotic add-on therapy during, before, and after second-line antibiotic regimens, quinolone-based sequential therapy for 10–14 days, quinolone-based bismuth quadruple therapy for 10–14 days, bismuth quadruple therapy for 10–14 days, and quinolone-based triple therapy for 10–14 days were significantly superior to the other regimens. Subgroup analysis of countries with high clarithromycin resistance and high levofloxacin resistance revealed that the ranking of second-line eradication regimens was distributed similarly in each group, as well as in patients with failure of first-line triple therapy.ConclusionWe conducted a detailed comparison of second-line H. pylori regimens according to different antibiotic resistance rates and the results suggest alternative treatment choices with potential benefits beyond those that could be achieved using salvage therapies recommended by guidelines.

scholarly journals Helicobacter pylorieradication treatment for gastric carcinoma prevention in asymptomatic or dyspeptic adults: systematic review and Bayesian meta-analysis of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e026002 ◽  
Author(s):  
Teruhiko Terasawa ◽  
Chisato Hamashima ◽  
Katsuaki Kato ◽  
Isao Miyashiro ◽  
Takaki Yoshikawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastric Carcinoma ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
H Pylori ◽  
Randomised Controlled ◽  
Carcinoma Risk

ObjectivesRecent meta-analyses of eradication therapy inHelicobacter pylori-infected adults reported significant reductions in gastric carcinoma risk. However, concerns about supporting unfocused screening and eradication programme in healthy, asymptomatic populations have arisen. We performed a systematic review and Bayesian meta-analysis to provide an accurate interpretation of randomised evidence on the preventive effectiveness of eradication therapy on gastric carcinoma risk.MethodsWe searched databases including PubMed, Cochrane Central and Embase for reference and citation tracking without language restrictions, from inception through 31 July 2018. Paired investigators independently selected randomised controlled trials (RCTs) comparing eradication therapy with placebo or no treatment for asymptomatic or dyspepticH. pylori-infected adults with no previous gastric carcinoma. The main outcome was gastric carcinoma incidence; secondary outcomes included gastric carcinoma-specific, non-gastric carcinoma and all-cause mortality.ResultsA total of 5 population-based and 2 outpatient care-based RCTs involving 7303 adults were eligible. Eradication algorithms were heterogeneous, and unsuccessful eradication and reinfection were frequently observed. A Bayesian meta-analysis with competing risk outcomes found low-certainty evidence that eradication therapy might be more likely than control to reduce gastric carcinoma risk (HR=0.65; 95% credible interval (CrI) 0.41 to 1.0;I2=11%). The CrIs included the null effects across the subgroup and sensitivity analyses, apart from those based on particular models that excluded two RCTs that enrolled subjects with specific histological findings only (HR=0.55; CrI 0.30 to 0.89;I2=14%). The uncertainty of the average 41% risk reduction in gastric carcinoma-specific mortality included a clinically important mortality risk increase (HR=0.59 favouring eradication therapy; CrI 0.25 to 1.20;I2=13%; low certainty).ConclusionsThere is insufficient evidence to support or refute the effectiveness of eradication therapy in preventing gastric carcinoma inH. pylori-infected, high-risk populations. Rigorously conducted large RCTs of healthy infected adults only would provide evidence of the true efficacy of successful eradication.PROSPERO registration number:CRD42014009245.

scholarly journals High dose PPI-amoxicillin dual therapy for the treatment of Helicobacter pylori infection: a systematic review with meta-analysis

2020 ◽  
Vol 13 ◽  
pp. 175628482093711
Author(s):  
Yang-Jie Zhu ◽  
Yi Zhang ◽  
Ting-Yi Wang ◽  
Jing-Tao Zhao ◽  
Zhe Zhao ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Adverse Events ◽  
Eradication Rate ◽  
Meta Analysis ◽  
Dual Therapy ◽  
Controlled Trials ◽  
High Dose ◽  
First Line ◽  
Quadruple Therapy ◽  
H Pylori

Background: Helicobacter pylori resistance to amoxicillin remains rare in many regions. Proton pump inhibitor-amoxicillin-containing high dose dual therapy (HDDT) has been proposed to treat H. pylori infection. We aimed to assess the effectiveness and safety of PPI-amoxicillin HDDT for treatment of H. pylori infection in comparison with other regimens. Methods: Databases, including PubMed, Embase, and the Cochrane Register of Controlled Trials, were searched to find relevant publications. Randomized controlled trials comparing HDDT with control regimens for H. pylori eradication in adult patients were included. The primary outcome was eradication rate by intention-to-treat analysis. Adverse events were analyzed as second outcome. Results: A total of 15 trials with 3818 patients qualified for inclusion. The eradication rate of HDDT was neither significantly inferior nor superior to the recommended regimens such as triple therapy, bismuth quadruple therapy, and non-bismuth quadruple therapy [relative risk (RR): 1.00, 95% confidence interval (CI): 0.96–1.05, p = 0.870]. This finding was robust through subgroup analyses and sensitivity analyses. Trial sequential analysis showed that HDDT was equivalent to control regimens, and further similar trials were unlikely to alter the conclusions of this analysis. The frequency of adverse events was significantly lower in HDDT group (RR: 0.48, 95% CI: 0.37–0.64, p < 0.001). Conclusion: HDDT was equivalent to recommended first-line or rescue regimens with fewer adverse effects. The evidence from this meta-analysis supports the use of HDDT as first-line or rescue treatment for H. pylori infection. Trial registration: PROSPERO CRD42019133002

scholarly journals Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis

Gut ◽  
2020 ◽  
Vol 69 (12) ◽  
pp. 2113-2121 ◽  
Author(s):  
Alexander Charles Ford ◽  
Yuhong Yuan ◽  
Paul Moayyedi
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Helicobacter Pylori ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Healthy Individuals ◽  
Gastric Neoplasia ◽  
H Pylori ◽  
Related Mortality

ObjectivesGastric cancer is strongly associated with Helicobacter pylori (H. pylori). We conducted a previous systematic review and meta-analysis that suggested eradication therapy reduced future incidence of gastric cancer, but effect size was uncertain, and there was no reduction in gastric cancer-related mortality. We updated this meta-analysis, as more data has accumulated. We also evaluated impact of eradication therapy on future risk of gastric cancer in patients having endoscopic mucosal resection for gastric neoplasia.DesignWe searched the medical literature through February 2020 to identify randomised controlled trials (RCTs) examining effect of eradication therapy on subsequent occurrence of gastric cancer in healthy H. pylori-positive adults, and in H. pylori-positive patients with gastric neoplasia undergoing endoscopic mucosal resection. The control arm received placebo or no treatment. Follow-up was for ≥2 years. We estimated the relative risk (RR) number needed to treat (NNT), and evaluated the disability-adjusted life-years (DALYs) gained from screening from the meta-analysis.ResultsWe identified 10 RCTs, seven recruited 8323 healthy individuals, and three randomised 1841 patients with gastric neoplasia. In healthy individuals, eradication therapy reduced incidence of gastric cancer (RR=0.54; 95% CI 0.40 to 0.72, NNT=72), and reduced mortality from gastric cancer (RR=0.61; 95% CI 0.40 to 0.92, NNT=135), but did not affect all-cause mortality. These data suggest that 8 743 815 DALYs (95% CI 5 646 173 to 11 847 456) would be gained if population screening and treatment was implemented globally. In patients with gastric neoplasia, eradication therapy also reduced incidence of future gastric cancer (RR=0.49; 95% CI 0.34 to 0.70, NNT=21). Adverse events were incompletely reported.ConclusionThere is moderate evidence to suggest that H. pylori eradication therapy reduces the incidence of gastric cancer in healthy individuals and patients with gastric neoplasia in East Asian countries. There also appears to be a reduction in gastric cancer-related mortality.

scholarly journals Efficiency of the Inclusion of Rebamipide in the Eradication Therapy for Helicobacter pylori Infection: Meta-Analysis of Randomized Controlled Studies

2019 ◽  
Vol 8 (9) ◽  
pp. 1498 ◽  
Author(s):  
Dmitrii N. Andreev ◽  
Igor V. Maev ◽  
Diana T. Dicheva
Keyword(s):  
Helicobacter Pylori ◽  
Randomized Controlled Trials ◽  
Citation Index ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Therapy Regimen ◽  
Randomized Controlled ◽  
H Pylori

Background: There has been a negative trend in the effectiveness of classic eradication therapy regimens for Helicobacter pylori (H. pylori), which has largely been determined from the emergence and spread of antibiotic resistance. Several studies have shown that adding rebamipide to eradication regimens leads to an increase in the effectiveness of treatment. Aim: To evaluate the efficacy and safety of including rebamipide in the eradication regimens for H. pylori infection. Methods: The literature search was conducted in the MEDLINE/PubMed, EMBASE, Cochrane Central Register, Korean Medical Citation Index, and Russian Science Citation Index databases. All identified randomized controlled trials comparing rebamipide supplementation with non-rebamipide-containing eradication regimens for the treatment of H. pylori infection were included in the final analysis. Results: We identified 11 randomized controlled trials (RCTs) involving 1227 patients (631 in groups with rebamipide and 596 in groups without rebamipide). The meta-analysis showed that the addition of rebamipide to eradication regimens significantly increased the effectiveness of treatment (odds ratio (OR) 1.753, 95% confidence interval (CI) 1.312–2.333, p < 0.001). The subgroup analysis demonstrated that rebamipide significantly increased the effectiveness of eradication when added to a dual therapy regimen (OR 1.766, 95% CI: 1.167–2.495, p = 0.006); however, no significant improvement in effectiveness was observed when it was added to the triple therapy regimen (OR 1.638, 95% CI 0.833–3.219, p = 0.152). Conclusion: This meta-analysis demonstrated that the addition of rebamipide to H. pylori eradication regimens significantly increases the effectiveness of treatment.

scholarly journals Gut microbiota changes related to Helicobacter pylori eradication with vonoprazan containing triple therapy among adolescents: a prospective multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Toshihiko Kakiuchi ◽  
Kentaroh Yamamoto ◽  
Ichiro Imamura ◽  
Kazutoshi Hashiguchi ◽  
Hiroharu Kawakubo ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Adverse Events ◽  
Gut Microbiota ◽  
Relative Abundance ◽  
Eradication Therapy ◽  
Alpha Diversity ◽  
Serious Adverse Events ◽  
Pretreatment Condition ◽  
Stool Samples ◽  
H Pylori

AbstractCurrently, it is unclear whether treating Helicobacter pylori (H. pylori) infection is safe among adolescents. This study aimed to evaluate the safety of H. pylori eradication therapy by examining gut microbiota changes in adolescents 3 months after the therapy. H. pylori-infected adolescents were enrolled in this study. Their stool samples were collected at the following three time points: before treatment, 1–2 days after completion of treatment, and time of eradication successful judgment. We assessed the relative abundance, alpha-diversity, and beta-diversity of the gut microbiota and adverse events. The number of isolated Actinobacteria decreased immediately after eradication therapy in the 16 students included in the study, and it returned to pretreatment condition at the eradication judgment point. There was no change in the relative abundance at genus level. The alpha-diversity was lost immediately after eradication therapy; however, it recovered at the time of eradication judgment, and it was restored to pretreatment condition. Meanwhile, none of the participants experienced serious adverse events. H. pylori eradication therapy is safe for adolescents with respect to gut microbiota changes associated with H. pylori eradication therapy. Therefore, further long-term evaluations of gut microbiota changes following eradication therapy are warranted.

scholarly journals Risk of Reflux-Related Symptoms and Reflux Esophagitis after Helicobacter pylori Eradication Treatment in the Japanese Population

2021 ◽  
Vol 10 (7) ◽  
pp. 1434
Author(s):  
Mitsushige Sugimoto ◽  
Masaki Murata ◽  
Eri Iwata ◽  
Naoyoshi Nagata ◽  
Takao Itoi ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Reflux Esophagitis ◽  
Odds Ratio ◽  
Japanese Population ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Helicobacter Pylori Eradication ◽  
Different Populations ◽  
H Pylori ◽  
Japanese Subjects

Backgrounds: A meta-analysis of reports primarily from Western countries showed no association between Helicobacter pylori eradication and reflux esophagitis development. The risk of reflux esophagitis may differ among different populations based on H. pylori virulence factors and acid secretion ability. We evaluated the prevalence rates of reflux esophagitis in H.-pylori-positive Japanese subjects and assessed risk factors for reflux esophagitis after eradication. Methods: Among 148 H.-pylori-positive subjects who underwent H. pylori eradication from August 2015 to December 2019, we evaluated the prevalence of reflux esophagitis on endoscopy at 12 months after eradication success and the severity of reflux-related symptoms by the F-scale questionnaire at 2 months after treatment and 12 months after eradication success. Results: The prevalence of reflux esophagitis in H.-pylori-positive patients at entry was 2.0% (3/148). At 12 months after eradication success, the prevalence was 10.8% (16/148) (p < 0.01). In the F scale, the median total score before treatment was 4 (range: 0–49), which significantly decreased to 2 (range: 0–22) (p < 0.01) at 2 months after treatment and 3 (range: 0–23) (p < 0.01) at 12 months after eradication success. Following multivariate analysis, the pretreatment total F-scale score was a risk factor for the development of reflux esophagitis (odds ratio: 1.069, 95% confidence interval: 1.003–1.139, p < 0.01). Conclusions: In this H.-pylori-positive Japanese population, eradication therapy was associated with reflux esophagitis in around 10% of patients, particularly in those with severe reflux-related symptoms at baseline. Reflux-related symptoms may improve throughout the 12 months after successful eradication therapy, irrespective of the development of reflux esophagitis.

Sign in / Sign up

Export Citation Format

Share Document