title: Nonbismuth concomitant quadruple therapy for Helicobacter pylori eradication in Chinese regions: A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate the applicability of nonbismuth concomitant quadruple therapy for Helicobacter pylori (H. pylori) eradication in Chinese regions.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the efficacy of nonbismuth concomitant quadruple therapy between sequential therapy or triple therapy for H. pylori eradication in Chinese regions. The defined Chinese regions include China, Hong Kong, Taiwan, and Singapore. The primary outcome was the H. pylori eradication rate; the secondary outcome was the compliance with therapy. The PubMed, Embase, Scopus, and Cochrane databases were searched for studies published in the period up to March 2016 with no language restriction.
  
  
  RESULTS
  We reviewed six randomized controlled trials and 1616 patients. In 3 trials comparing concomitant quadruple therapy with triple therapy, the H. pylori eradication rate was significantly higher for 7-d nonbismuth concomitant quadruple therapy than for 7-d triple therapy (91.2% vs 77.9%, risk ratio = 1.17, 95%CI: 1.09-1.25). In 3 trials comparing quadruple therapy with sequential therapy, the eradication rate was not significant between groups (86.9% vs 86.0%). However, higher compliance was achieved with concomitant therapy than with sequential therapy.
  
  
  CONCLUSIONS
  The H. pylori eradication rate was higher for nonbismuth concomitant quadruple therapy than for triple therapy. Moreover, higher compliance was achieved with nonbismuth concomitant quadruple therapy than with sequential therapy. Thus, nonbismuth concomitant quadruple therapy should be the first-line treatment in Chinese regions.
authors.affiliation: Lien-Chieh Lin, Tzu-Herng Hsu, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Lien-Chieh
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Lien-Chieh Lin, Tzu-Herng Hsu, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Tzu-Herng
authors.initials: TH
authors.lastname: Hsu
authors.affiliation: Lien-Chieh Lin, Tzu-Herng Hsu, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Kuang-Wei
authors.initials: KW
authors.lastname: Huang
authors.affiliation: Lien-Chieh Lin, Tzu-Herng Hsu, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D017291:Clarithromycin / Q000627:therapeutic use; D060740:Disease Eradication / Q000379:methods; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D010349:Patient Compliance; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012846:Singapore / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Chinese region; Helicobacter pylori eradication; Nonbismuth concomitant quadruple therapy; Peptic ulcer