title: Is short-term therapy really sufficient to eradicate Helicobacter pylori infection?
abstract: OBJECTIVE
  The aim of our study was to perform a systematic review and meta-analysis of the efficacy of short-term protocols for Helicobacter pylori eradication and to review the safety and adverse profiles of these eradication protocols.
  
  
  METHODS
  Literatures were located through electronic searches by PubMed, Medline, ISI Web of Knowledge, and Cochrane Library using the relevant terms. Abstracts of important meetings were searched manually in some journal supplements. Additional bibliographies were identified from the reference lists of identified studies. Three independent reviewers systemically identified randomized controlled trials (RCTs) comparing short-duration protocols vs. 7-d proton pump inhibitor (PPI)-based triple protocols, as well as studies reporting eradication rates of short-duration protocols for H. pylori. Summary effect size was calculated as relative risk (RR) and 95% confidence intervals (CI) using Review Manager 4.2, and P<0.05 was defined as statistically significant in all analyses.
  
  
  RESULTS
  Among 90 abstracts retrieved, 15 studies were analyzed, including a total of 30 treatment regimens with 1856 subjects. Mean intention-to-treat (ITT) cure rates of 63.2% and 81.3% were achieved with short-term protocols and 7-d PPI-containing protocols, respectively. Per-protocol (PP)-based overall cure rates were 66.6% and 86.1%, respectively. Short-term therapy was inferior to 7-d triple regimen (P<0.00001). After sub-analysis, however, comparing the effects of > or = 3-d protocols and 7-d triple protocols, the cumulative ITT RR was 0.95 (P=0.26), and PP RR was 0.95 (P=0.10), without significant heterogeneity. Moreover, slightly fewer adverse-effects were found in short-term protocols.
  
  
  CONCLUSIONS
  Although more economical, short-duration protocols are inferior to 7-d PPI-based triple protocols with regarding to eradication rate of H. pylori. Protocols of more than 3 d, however, may be equivalent to 7-d protocols.
authors.affiliation: Department of Gastroenterology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhou
authors.forename: Wei-xing
authors.initials: WX
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Lan
authors.initials: L
authors.lastname: Li
authors.forename: Xi
authors.initials: X
authors.lastname: Jin
authors.forename: You-ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000254:growth & development*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
references.citation: Aliment Pharmacol Ther. 2001 Mar;15(3):417-21
references.pmid: 11207518
references.citation: Dig Liver Dis. 2003 Nov;35(11):763-7
references.pmid: 14674665
references.citation: Am J Gastroenterol. 1998 Sep;93(9):1436-42
references.pmid: 9732921
references.citation: Z Gastroenterol. 2000 Sep;38(9):807-12
references.pmid: 11072679
references.citation: Ann Intern Med. 2008 Jun 17;148(12):923-31
references.pmid: 18490667
references.citation: Helicobacter. 2007 Aug;12(4):275-8
references.pmid: 17669098
references.citation: Arch Intern Med. 2003 Sep 22;163(17):2079-84
references.pmid: 14504122
references.citation: Ann Intern Med. 2007 Oct 16;147(8):553-62
references.pmid: 17938394
references.citation: Aliment Pharmacol Ther. 1999 Jan;13(1):43-7
references.pmid: 9892878
references.citation: World J Gastroenterol. 2006 May 21;12(19):3105-7
references.pmid: 16718797
references.citation: Chin J Dig Dis. 2005;6(4):202-5
references.pmid: 16246231
references.citation: Scand J Gastroenterol. 2001 Jun;36(6):584-8
references.pmid: 11424316
references.citation: Control Clin Trials. 1996 Feb;17(1):1-12
references.pmid: 8721797
references.citation: Helicobacter. 2005 Jun;10(3):157-71
references.pmid: 15904473
references.citation: J Gastroenterol Hepatol. 2003 Jan;18(1):13-7
references.pmid: 12519218
references.citation: World J Gastroenterol. 2006 Jun 28;12(24):3915-8
references.pmid: 16804982
references.citation: Helicobacter. 1998 Mar;3(1):54-8
references.pmid: 9546119
references.citation: Helicobacter. 2007 Feb;12(1):31-5
references.pmid: 17241298
references.citation: J Clin Gastroenterol. 2006 Jul;40(6):515-20
references.pmid: 16825934
references.citation: Pol Arch Med Wewn. 2000 Sep;104(3):569-74
references.pmid: 11392163
references.citation: Dig Dis Sci. 2009 Nov;54(11):2303-11
references.pmid: 19107596
references.citation: Aliment Pharmacol Ther. 1996 Aug;10(4):645-50
references.pmid: 8853771
references.citation: Am J Gastroenterol. 1992 Nov;87(11):1587-90
references.pmid: 1442678
references.citation: Aliment Pharmacol Ther. 1999 Jul;13(7):869-73
references.pmid: 10383520
references.citation: J Formos Med Assoc. 2003 Dec;102(12):857-62
references.pmid: 14976565
references.citation: Aliment Pharmacol Ther. 2001 Dec;15(12):1959-65
references.pmid: 11736727
references.citation: Gut. 1997 Dec;41(6):735-9
references.pmid: 9462204
references.citation: Aliment Pharmacol Ther. 2001 Jun;15(6):843-9
references.pmid: 11380322
references.citation: Int J Epidemiol. 2002 Feb;31(1):128-39
references.pmid: 11914309
references.citation: Dig Dis Sci. 2008 Nov;53(11):2837-46
references.pmid: 18427992
references.citation: Expert Opin Pharmacother. 2007 Nov;8(16):2701-17
references.pmid: 17956193
references.citation: Rheumatology (Oxford). 2007 Aug;46(8):1223-33
references.pmid: 17522095
references.citation: Aliment Pharmacol Ther. 2003 Sep 15;18(6):647-54
references.pmid: 12969092
references.citation: Dig Dis Sci. 1993 Sep;38(9):1670-3
references.pmid: 8359079
references.citation: Aliment Pharmacol Ther. 2000 Dec;14(12):1619-23
references.pmid: 11121910
references.citation: Am J Gastroenterol. 1998 May;93(5):737-42
references.pmid: 9625119
references.citation: Helicobacter. 1997 Jun;2(2):106
references.pmid: 9432327
references.citation: Aliment Pharmacol Ther. 2006 Jan 1;23(1):35-44
references.pmid: 16393278
references.citation: Dig Liver Dis. 2000 Jan-Feb;32(1):71-3
references.pmid: 10975761
references.citation: Am J Gastroenterol. 1994 May;89(5):731-3
references.pmid: 8172147
references.citation: Am J Gastroenterol. 1996 Feb;91(2):246-57
references.pmid: 8607488
references.citation: J Am Geriatr Soc. 1999 Jun;47(6):720-2
references.pmid: 10366173
references.citation: Aliment Pharmacol Ther. 1999 Feb;13(2):173-7
references.pmid: 10102947
references.citation: Am J Gastroenterol. 1998 Mar;93(3):390-3
references.pmid: 9517646
references.citation: Adv Med Sci. 2008;53(2):310-5
references.pmid: 18952538
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1789-98
references.pmid: 17521398
references.citation: Aliment Pharmacol Ther. 2000 Jun;14(6):759-66
references.pmid: 10848660
references.citation: Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2004 Oct;29(5):589-91
references.pmid: 16137055