Systematic Review and Meta-Analysis: Bismuth Enhances the Efficacy for Eradication of Helicobacter pylori

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-10-09 DOI:10.1111/hel.13141

A Reum Choe, Chung Hyun Tae, Miyoung Choi, Ki-Nam Shim, Hye-Kyung Jung

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引用次数: 0

Abstract

Background

In the eradication of Helicobacter pylori, the efficacy of bismuth remains inconclusive. We aimed to compare the efficacy of bismuth on various H. pylori eradication regimens.

Methods

Randomized controlled trials were collected to compare the efficacy of bismuth to nonbismuth regimens in H. pylori eradication. We pooled information to study eradication, adverse events, and drug compliance. In addition, subgroup analyses for eradication efficacy were performed according to high or low clarithromycin-resistance area, bismuth drug form, and amount of bismuth element.

Results

Records for a total of 2506 patients in 15 trials from 13 randomized controlled studies were included. The eradication of H. pylori was superior when bismuth compared to nonbismuth regimen (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.33–2.00 in intention-to-treat [ITT]; OR = 2.05, 95% CI, 1.58–2.68 in per-protocol [PP] analyses), without significant difference in drug compliance or adverse events. Bismuth regimens in the high clarithromycin resistance area tend to enhance the eradication rate (OR = 1.66, 95% CI, 1.34–2.05 in ITT; OR = 2.22, 95% CI, 1.67–2.95 in PP analyses). Bismuth potassium citrate and bismuth subcitrate were more effective drug forms in regard to eradication rate. Bismuth at a dosage of < 500 mg/day was significantly higher for the eradication rate.

Conclusions

Bismuth to the H. pylori eradication regimens achieve a higher eradication rate, especially in the high clarithromycin resistance area. It could be an eradication option achieving sufficient resistance rates without increasing antibiotic resistance, side effects, or poor compliance.

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系统回顾与元分析：铋能增强根除幽门螺旋杆菌的疗效。

背景：在根除幽门螺杆菌方面，铋剂的疗效仍无定论。我们旨在比较铋剂对各种幽门螺杆菌根除方案的疗效：我们收集了随机对照试验，以比较铋剂与非铋剂方案在根除幽门螺杆菌方面的疗效。我们汇总了研究根除率、不良事件和药物依从性的信息。此外，我们还根据克拉霉素耐药区的高低、铋剂的药物形式和铋元素的含量对根除效果进行了亚组分析：结果：共纳入了 13 项随机对照研究的 15 项试验中 2506 名患者的记录。与非铋剂方案相比，铋剂方案根除幽门螺杆菌的效果更佳（意向治疗[ITT]中的比值比[OR]=1.63，95%置信区间[CI]，1.33-2.00；按方案[PP]分析中的比值比[OR]=2.05，95%置信区间[CI]，1.58-2.68），但在用药依从性或不良事件方面无显著差异。克拉霉素耐药性高发区的铋剂方案往往会提高根除率（ITT OR = 1.66，95% CI，1.34-2.05；PP 分析中 OR = 2.22，95% CI，1.67-2.95）。就根除率而言，枸橼酸铋钾和次枸橼酸铋是更有效的药物形式。结论：铋的用量为枸橼酸铋钾和次枸橼酸铋钾：在幽门螺杆菌根除方案中加入铋剂可获得更高的根除率，尤其是在克拉霉素耐药率较高的地区。它可以作为一种根除方案，在不增加抗生素耐药性、副作用或依从性差的情况下达到足够的耐药率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.