Meta-analysis of first-line triple therapy for helicobacter pylori eradication in Korea: is it time to change?
Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Eun Jeong
0000-0003-3996-3472
EJ
Gong
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung-Cheol
0000-0001-8503-109X
SC
Yun
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Hwoon-Yong
0000-0003-1281-5859
HY
Jung
Department of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Hyun
0000-0001-6581-6420
H
Lim
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kwi-Sook
0000-0002-1190-7092
KS
Choi
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Ji Yong
0000-0002-0030-3744
JY
Ahn
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jeong Hoon
0000-0002-0778-7585
JH
Lee
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Do Hoon
0000-0002-4250-4683
DH
Kim
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kee Don
0000-0002-2517-4109
KD
Choi
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Ho June
0000-0001-9255-1464
HJ
Song
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Gin Hyug
0000-0003-3776-3928
GH
Lee
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jin-Ho
0000-0002-6533-3127
JH
Kim
D000477:Alkylating Agents / Q000627:therapeutic use; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D003140:Communicable Disease Control; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000627:therapeutic use; D060740:Disease Eradication; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005756:Gastritis / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D056910:Republic of Korea; D014011:Tinidazole / Q000627:therapeutic use
D000477:Alkylating Agents; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D054328:Proton Pump Inhibitors; D014011:Tinidazole; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
Eradication; Helicobacter pylori; Triple Therapy