Impact of Helicobacter pylori Antibiotic Resistance on Treatment Outcomes in Gastrointestinal Lymphomas: A Meta-Analysis.

Abstract

Aims/Background With the increasing prevalence of antibiotic-resistant strains of Helicobacter pylori (H. pylori), especially in the context of its association with gastrointestinal (GI) lymphomas, understanding the current patterns of resistance and their implications for treatment strategies is crucial. Our study aims to investigate the antibiotic resistance patterns of H. pylori in patients with GI lymphoma. Methods A comprehensive literature search was conducted using major electronic databases up to August 2023. The primary focus was on the antibiotic resistance patterns of H. pylori in GI lymphoma. The data included study characteristics, patient demographics, details of H. pylori antibiotic resistance, and outcomes such as all-cause mortality (AM), tumor progression rate (TPR), clinical cure rate (CCR), and long-term recurrence rate (LRR) following initial cure in patients with GI lymphoma. Results From 2325 identified articles, 9 were included, representing 934 patients with GI lymphoma. Significant differences in AM were observed in patients who were resistant to clarithromycin (standard mean difference, SMD: 2.27, 95% confidence intervals, CIs: 0.63 to 3.91, p = 0.007) and there were no differences in AM between amoxicillin-resistant patients and controls (SMD: 1.35, 95% CIs: -0.54 to 3.25, p = 0.16). Patients who were resistant to both clarithromycin and amoxicillin showed a pronounced difference in AM (SMD: 5.13, 95% CIs: 1.78 to 8.48, p = 0.003). Clarithromycin resistance significantly affected CCR after H. pylori eradication therapy (SMD: -4.12, 95% CIs: -5.42 to -2.82, p < 0.00001). Elevated TPR was observed in patients who were resistant to clarithromycin (SMD: 7.09, 95% CIs: 4.57 to 9.61, p < 0.00001) and amoxicillin (SMD: 11.03, 95% CIs: 5.81 to 16.25, p < 0.0001). LRR also exhibited significant differences in patients who were resistant to clarithromycin (SMD: 9.31, 95% CIs: 6.16 to 12.47, p < 0.00001) and amoxicillin (SMD: 13.81, 95% CIs: 2.78 to 24.85, p = 0.01). Conclusion Increasing antibiotic resistance in H. pylori strains poses a significant challenge for the treatment of GI lymphomas. Tailored treatment strategies in which resistance patterns are imperative for effective management and improved patient outcomes.