Published online Jun 21, 2016. doi: 10.3748/wjg.v22.i23.5445
Peer-review started: March 18, 2016
First decision: March 31, 2016
Revised: April 8, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 21, 2016
AIM: 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.
CONCLUSION: 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.
Core tip:Helicobacter pylori (H. pylori) infection is highly prevalent in Chinese regions and associated with peptic ulcers. Currently, triple and sequential therapies have been widely used to eradicate H. pylori. Nonbismuth concomitant quadruple therapy is an alternative treatment with high efficacy. Our meta-analysis revealed that a higher H. pylori eradication rate was achieved with 7-d concomitant therapy than with 7-d triple therapy. The eradication rates of concomitant and sequential therapies were similar. However, the compliance with concomitant therapy was higher. Therefore, nonbismuth concomitant quadruple therapy should be the first-line treatment for H. pylori infection.