Meta-analysis To Compare The Efficacy Of Sequential Therapy And Triple Therapy For Helicobacter Pylori Eradication

Background：Eradication rate of triple therapy goes down yearly. Some studies concerning thesequential therapy(ST) for Helicobacter pylori (Hp) elimination have reported bydomestic and international scholars. To compare the curative effect of ST and TT forHp elimination using evidence-based medicine may bring certain guide value inclinical diagnosis and management.Objective：Our aim was to compare the curative effect of ST and TT for Hp eradication byperforming Meta-analysis.Methods：Cochrane systematic review was used and the appropriate search terms, retrievalperiod, databases were choosed. RCTs of comparison the treatment outcome of STand TT for Hp elimination were included, Data was extracted and the quality of theRCTs was assessed, Heterogeneity test were assessed to the studies. Appropriateeffect model and Meta analyses were determined according to the result ofheterogeneity test. At the same time, subgroup analysis, sensitivity analyses, safetyevaluation, publication bias were considered.Results：11RCTs literatures were included. Jadad scale showed high quality in2literatures,medium quality in5literatures, low quality in4literatures. Cochrane risk assessmentshowed low risk in selection bias, attrition bias, reporting bias, and high risk inperformance bias, detection bias and other bias. Meta-analysis showed that the ORwas3.39with the95%confidence interval(CI)2.66-4.33, there was obviousdifference in the eradication rate between ST group and TT group(Z=9.87,P<0.00001)in Intention-To-Treat(ITT) analysis. The OR was4.76with the95%confidenceinterval(CI)3.53-6.40, there was obvious difference in the eradication rate betweenST group and TT group(Z=10.29,P<0.00001) in Per-Protocol(PP) analysis. Sequential therapy appeared superior in subgroup analyses which include adult; children; China.The side effects ratios between ST group and TT group had no difference.Conclusions：ST seems to outperform TT for Hp eradication. However, the superiority of STfor Hp eradication will be verified by the larger sample size and multicenter of RCTsbefore few and low quality of literatures.