{"title":"根除幽门螺旋杆菌的大剂量双重疗法与含铋四联疗法：系统综述和荟萃分析以及试验序列分析。","authors":"Ben-Gang Zhou, Yu-Zhou Mei, Min Zhang, Xin Jiang, Yao-Yao Li, Yan-Bing Ding","doi":"10.1177/17562848221147756","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) <i>versus</i> bismuth-containing quadruple therapy (BQT) for <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication have been published with controversial and inconsistent conclusions. The aim of this meta-analysis was to determine the effects of HDDT for <i>H. pylori</i> eradication compared to BQT.</p><p><strong>Design: </strong>A systematic review and meta-analysis was conducted.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane library database were searched to collect all randomized controlled trials (RCTs) assessing the effects of HDDT <i>versus</i> BQT to <i>H. pylori</i> eradication from inception to September 2022. Meta-analysis was conducted to estimate the pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effects model. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis (TSA) was performed to determine the reliability and conclusiveness.</p><p><strong>Results: </strong>A total of 14 RCTs with 5121 patients were included. The results of meta-analysis showed that there was no statistical significance in the eradication rate between HDDT and BQT (intention-to-treat analysis: 86.7% <i>versus</i> 85.1%, RR = 1.01, 95% CI: 0.98-1.04; per-protocol analysis: 89.9% <i>versus</i> 89.4%, RR = 1.01, 95% CI: 0.98-1.03; moderate-quality evidence). The incidence of total adverse effects in HDDT group was significantly lower than in BQT group (5.9% <i>versus</i> 34.1%, RR = 0.42, 95% CI: 0.34-0.50; low-quality evidence). No statistical significance was observed in compliance between HDDT and BQT (RR = 1.01, 95% CI, 1.00-1.03, <i>p</i> = 0.07; low-quality evidence). The TSA result for <i>H. pylori</i> eradication rate indicated that the effect was conclusive.</p><p><strong>Conclusions: </strong>Evidence from our updated meta-analysis suggests that HDDT is as effective as BQT in eradicating <i>H. pylori</i>, with fewer adverse effects and similar compliance.</p><p><strong>Registration: </strong>Open Science Framework registries (No: osf.io/th4vd).</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848221147756"},"PeriodicalIF":4.2000,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/23/10.1177_17562848221147756.PMC9837272.pdf","citationCount":"0","resultStr":"{\"title\":\"High-dose dual therapy <i>versus</i> bismuth-containing quadruple therapy for <i>Helicobacter pylori</i> eradication: a systematic review and meta-analysis with trial sequential analysis.\",\"authors\":\"Ben-Gang Zhou, Yu-Zhou Mei, Min Zhang, Xin Jiang, Yao-Yao Li, Yan-Bing Ding\",\"doi\":\"10.1177/17562848221147756\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objective: </strong>Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) <i>versus</i> bismuth-containing quadruple therapy (BQT) for <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication have been published with controversial and inconsistent conclusions. The aim of this meta-analysis was to determine the effects of HDDT for <i>H. pylori</i> eradication compared to BQT.</p><p><strong>Design: </strong>A systematic review and meta-analysis was conducted.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane library database were searched to collect all randomized controlled trials (RCTs) assessing the effects of HDDT <i>versus</i> BQT to <i>H. pylori</i> eradication from inception to September 2022. Meta-analysis was conducted to estimate the pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effects model. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis (TSA) was performed to determine the reliability and conclusiveness.</p><p><strong>Results: </strong>A total of 14 RCTs with 5121 patients were included. The results of meta-analysis showed that there was no statistical significance in the eradication rate between HDDT and BQT (intention-to-treat analysis: 86.7% <i>versus</i> 85.1%, RR = 1.01, 95% CI: 0.98-1.04; per-protocol analysis: 89.9% <i>versus</i> 89.4%, RR = 1.01, 95% CI: 0.98-1.03; moderate-quality evidence). The incidence of total adverse effects in HDDT group was significantly lower than in BQT group (5.9% <i>versus</i> 34.1%, RR = 0.42, 95% CI: 0.34-0.50; low-quality evidence). No statistical significance was observed in compliance between HDDT and BQT (RR = 1.01, 95% CI, 1.00-1.03, <i>p</i> = 0.07; low-quality evidence). The TSA result for <i>H. pylori</i> eradication rate indicated that the effect was conclusive.</p><p><strong>Conclusions: </strong>Evidence from our updated meta-analysis suggests that HDDT is as effective as BQT in eradicating <i>H. pylori</i>, with fewer adverse effects and similar compliance.</p><p><strong>Registration: </strong>Open Science Framework registries (No: osf.io/th4vd).</p>\",\"PeriodicalId\":23022,\"journal\":{\"name\":\"Therapeutic Advances in Gastroenterology\",\"volume\":\"16 \",\"pages\":\"17562848221147756\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2023-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/23/10.1177_17562848221147756.PMC9837272.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Gastroenterology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17562848221147756\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562848221147756","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
High-dose dual therapy versus bismuth-containing quadruple therapy for Helicobacter pylori eradication: a systematic review and meta-analysis with trial sequential analysis.
Background and objective: Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) versus bismuth-containing quadruple therapy (BQT) for Helicobacter pylori (H. pylori) eradication have been published with controversial and inconsistent conclusions. The aim of this meta-analysis was to determine the effects of HDDT for H. pylori eradication compared to BQT.
Design: A systematic review and meta-analysis was conducted.
Methods: PubMed, Embase, and the Cochrane library database were searched to collect all randomized controlled trials (RCTs) assessing the effects of HDDT versus BQT to H. pylori eradication from inception to September 2022. Meta-analysis was conducted to estimate the pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effects model. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis (TSA) was performed to determine the reliability and conclusiveness.
Results: A total of 14 RCTs with 5121 patients were included. The results of meta-analysis showed that there was no statistical significance in the eradication rate between HDDT and BQT (intention-to-treat analysis: 86.7% versus 85.1%, RR = 1.01, 95% CI: 0.98-1.04; per-protocol analysis: 89.9% versus 89.4%, RR = 1.01, 95% CI: 0.98-1.03; moderate-quality evidence). The incidence of total adverse effects in HDDT group was significantly lower than in BQT group (5.9% versus 34.1%, RR = 0.42, 95% CI: 0.34-0.50; low-quality evidence). No statistical significance was observed in compliance between HDDT and BQT (RR = 1.01, 95% CI, 1.00-1.03, p = 0.07; low-quality evidence). The TSA result for H. pylori eradication rate indicated that the effect was conclusive.
Conclusions: Evidence from our updated meta-analysis suggests that HDDT is as effective as BQT in eradicating H. pylori, with fewer adverse effects and similar compliance.
Registration: Open Science Framework registries (No: osf.io/th4vd).
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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