| Background and objectiveHelicobacter pylori(H.pylori),an important hunman pathogen is involved in the development of many disease of the digestive tract.The eradication of H.pylori can reduce the source of infection,alleviate or cure the disease,reduce the occurrence,therefore it is necessary to eradicate H.pylori effectively.However,owing to the rapid increase of antibiotic resistance,the insufficiency in acid suppression function and the unreasonable eradication,H.pylori eradication therapy is facing a new dilemma.In this study,we carried out a systematic review with meta-analysis,to evaluate 10 or 14 days bismuth-based quadruple therapy for helicobacter pylori in China.MethodsThe systematic reviews/meta analyse on randomized controlled trials(RCTs)of 10 or 14 days bismuth-based quadruple therapy in china were searched in Pub Med,Embase,the Cochrane Central Register of Controlled Trials,the China National Knowledge Infrastructure database,the Chinese Biomedical Database and the VIP database,from the year of 2005 to 2016.Information retrieved included the clinical features of patients,eradication rate of H.pylori with each treatment and incidence of adverse events by two reviewers.Jadad scale which evaluated the quality of the included studies was useed.The Meta-analysis evaluation software Revman 5.3 was applied to analyzed the obtained data.The pooled relative risk(RR)and 95%confidence intervals(CIs)were calculated,and the publication bias was assessed with funnel plot.ResultsA total of 43 RCTs of 7686 patient were eligible for inclusion.Compared with triple therapy and 7 days bismuth-based quadruple therapy,bismuth-based quadruple therapy for 10 or 14 days showed the highest effectiveness(RR=1.20,95% CI:1.16%~1.25%)RR=1.07,95% CI:1.02%~1.12%).The eradication rate of bismuth-based quadruple therapy for 10 or 14 days and triple therapy were 88.96%(95% CI:87.73%~90.19%)and 74.11%(95% CI:72.53%~75.69%)(intention-to-treat),and 87.34%(95% CI:84.87%~89.80%),81.65%(95% CI:78.76%~84.54%)in 10 or 14 days bismuth-based quadruple therapy and 7days bismuth quadruple therapy.No significant diffience were fond between 10 or 14 days bismuth quadruple therapy and sequetial therapy(RR=1.02,95% CI:0.97%~1.07%)or 10 or 14 days bismuth-based quadruple therapy and concomitant therapy(RR=1.01,95% CI:0.95%~1.07%).ConclusionThe 10 or 14 days bismuth-based quadruple therapy,sequetial therapy or concomitant therapy have considerable efficacy in H.pylori eradication,whereas,triple therapy and 7day bismuth quadruple therapy can not be used as the preferred treatment.Background and Objective:Unlike clarithromycin,helicobacter pylori to amoxicillin,either primary or secondary resistance are extremely low.Studies have reported that high dose dual therapy according to characteristics of amoxicillin such as the time-dependence and PH-dependence combined with high dose of proton pump can obtain satisfactory curative effect.To investigated whether a combination of a high-dose proton pump inhibitor and amoxicillin(dual therapy)was more effective than bismuth contained quadruple therapy which used as first-line therapy in our country.Method Two hundred and sixty-three patients with Helicobacter Pylori infection defined by 13 C urea breath test,rapid urease test or Helicobacter Pylori culture were randomly assigned into three groups based on the random number table designed by excell.Group A(n=87): rabeprazole 10 mg plus amoxicillin 750 mg,4times/day for 14days;Group B(n=87):rabeprazole 20 mg plus amoxicillin 750 mg,4times /days for 14days;Group C(n=89):bismuth-containing quadruple regimen for 14 days(rabeprazole20mg,bismuth 220 mg,amoxicillin1000mg,clarithromycin500 mg,2times /days).Helicobacter Pylori infection was determered by using 13 C urea breath test after 4 week.Result By ITT and PP analysis,eradication rates in three groups were 78.1%(95% CI,68.4%-86.8 %)and 79.1%(95% CI,70.5%-87.7%)in group A;81.6%(95% CI,73.5%-89.7%)and 83.5%(95% CI,75.6%-91.4%)in group B;84.3%(95% CI,76.7%-91.9%)and86.2%(95% CI,75.6%-91.4%)in group C.No significant eradication rates was found between each group(P>0.05).Incidence of total adverse events in three groups was 3.4%?5.7% and 11.2%(P>0.05),but occurrence of side effects such as parageusia(P=0.002)and black teeth and tongue(P=0.002)seemed to be higher in group C than group A or B.Conclusion high-dose dual therapy is not superior to standard bismuth contained quadruple therapy which used as first-line therapy for Helicobacter Pylori eradication. |
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