Evaluation of treatment regimens to cure Helicobacter pylori infection--a meta-analysis.
OBJECTIVE
To assess effectiveness of treatment to cure Helicobacter pylori infection.


RESULTS
Meta-analysis of 666 manuscripts (full papers, abstracts, letters to the editor) identified through Medline and a manual search (1986 to January 1998). Data were overviewed by regression analysis with weighted random effects models.


METHODS
53 228 patients with H. pylori infection.


METHODS
Patients were treated with 132 different medication combinations.


METHODS
Cure of H. pylori infection per protocol and intention-to-treat basis at least 28 days after treatment.


RESULTS
The nationality of the patients and therapeutic regimen have a significant impact on the results, after correction for the heterogeneity in the precision of the cure rate caused by different study sizes and random effect for study. On the basis of the original sample size, cure rates of 80-85% were achieved using combinations of a proton-pump inhibitor or ranitidine bismuth citrate with two antibiotics including clarithromycin, amoxycillin and metronidazole or tinidazole. Comparable cure rates were also achieved using a combination of a proton-pump inhibitor or H2-receptor antagonist with bismuth subcitrate or tripotassium dicitrato bismuthate, metronidazole and tetracycline. The dose of clarithromycin influenced cure rates. Treatment duration did not influence the outcome.


CONCLUSIONS
Several therapeutic regimens are eligible to cure H. pylori infection. However, none of the medication combinations were able to cure H. pylori infection in more than 85% of the patients assessed by intention-to-treat. The countries in which the studies were performed also had a significant impact on eradication rates.
Laheij
R J
RJ
Department of Gastroenterology, University Hospital Nijmegen, The Netherlands. r.laheij@mie.kun.nl
Rossum
L G
LG
Jansen
J B
JB
Straatman
H
H
Verbeek
A L
AL
D000863:Antacids / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D014943:Global Health; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D054328:Proton Pump Inhibitors; D012044:Regression Analysis
D000863:Antacids; D000900:Anti-Bacterial Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D001729:Bismuth