Sequential therapy vs. standard triple therapies for Helicobacter pylori infection: a meta-analysis

Authors

  • J. L. Tong PhD,

    1. Department of Gastroenterology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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  • Z. H. Ran MD,

    1. Department of Gastroenterology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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  • J. Shen PhD,

    1. Department of Gastroenterology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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  • S. D. Xiao MD

    1. Department of Gastroenterology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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Dr Z. H. Ran, Department of Gastroenterology, Ren ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai 200001, China. Tel.: +86 21 63260930; fax: +86 21 63266027; e-mail: z-ran@online.sh.cn

Summary

Background:  As standard triple therapies of achieve unsatisfactory eradication of Helicobacter pylori, several alternative regimens have been proposed.

Objectives:  To systematically evaluate whether sequential treatment eradicates H. pylori infection better than standard triple therapies and compare the risk of adverse events with these two regimens.

Methods:  We searched electronic databases up to February 2008 for studies evaluating the efficacy of the 10-day sequential therapy vs. standard triple regimens for eradication of H. pylori. The pooled risk ratios (RR) and 95% confidence intervals (95% CI) were calculated.

Results:  We identified 11 randomized trials, including eight full-text manuscripts and three abstracts. Pooled analysis demonstrated clear superiority of the sequential therapy over 7-day triple regimen with an RR of 1·23 (95% CI 1·19–1·27), and over 10-day triple regimen with a RR of 1·16 (95% CI 1·10–1·23). Adverse event rates were similar. For sequential therapy vs. 7-day triple therapies, RR = 0·96, 95% CI 0·70–1·31.

Conclusions:  Sequential therapy was associated with a higher eradication rate of H. pylori compared with both 7-day triple regimen and 10-day triple regimen.

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