PMID- 27460211
OWN - NLM
STAT- MEDLINE
DCOM- 20170131
LR  - 20181202
IS  - 1471-230X (Electronic)
IS  - 1471-230X (Linking)
VI  - 16
IP  - 1
DP  - 2016 Jul 26
TI  - Pharmacological regimens for eradication of Helicobacter pylori: an overview of 
      systematic reviews and network meta-analysis.
PG  - 80
LID - 10.1186/s12876-016-0491-7 [doi]
LID - 80
AB  - BACKGROUND: Approximately half of the world's population is infected with 
      Helicobacter pylori (H.pylori), a bacterium shown to be linked with a series of 
      gastrointestinal diseases. A growing number of systematic reviews (SRs) have been 
      published comparing the effectiveness of different treatments for H.pylori 
      infection but have not reached a consistent conclusion. The objective of this 
      study is to provide an overview of SRs of pharmacological therapies for the 
      eradication of H.pylori. METHODS: Major electronic databases were searched to 
      identify relevant SRs published between 2002 and February 2016. Studies were 
      considered eligible if they included RCTs comparing different pharmacological 
      regimens for treating patients diagnosed as H.pylori infected and pooled the 
      eradication rates in a meta-analysis. A modified version of the 'A Measurement 
      Tool to Assess Systematic Reviews' (AMSTAR) was used to assess the methodological 
      quality. A Bayesian random effects network meta-analysis (NMA) was conducted to 
      compare the different proton pump inhibitors (PPI) within triple therapy. 
      RESULTS: 30 SRs with pairwise meta-analysis were included. In triple therapy, the 
      NMA ranked the esomeprazole to be the most effective PPI, followed by 
      rabeprazole, while no difference was observed among the three old generations of 
      PPI for the eradication of H.pylori. When comparing triple and bismuth-based 
      therapy, the relative effectiveness appeared to be dependent on the choice of 
      antibiotics within the triple therapy; moxifloxacin or levofloxacin-based triple 
      therapy were both associated with greater effectiveness than bismuth-based 
      therapy as a second-line treatment, while bismuth-based therapy achieved similar 
      or greater eradication rate compared to clarithromycin-based therapy. 
      Inconsistent findings were reported regarding the use of 
      levofloxacin/moxifloxacin in the first-line treatment; this could be due to the 
      varied resistant rate to different antibiotics across regions and populations. 
      Critical appraisal showed a low-moderate level of overall methodological quality 
      of included studies. CONCLUSIONS: Our analysis suggests that the new generation 
      of PPIs and use of moxifloxacin or levofloxacin within triple therapy as 
      second-line treatment were associated with greater effectiveness. Given the 
      varied antibiotic resistant rate across regions, the appropriateness of pooling 
      results together in meta-analysis should be carefully considered and the 
      recommendation of the choice of antibiotics should be localized.
FAU - Xin, Yiqiao
AU  - Xin Y
AUID- ORCID: 0000-0001-5856-3103
AD  - Health Economics and Health Technology Assessment (HEHTA), Institute of Health 
      and Wellbeing, University of Glasgow, Glasgow, UK. yiqiao.xin@glasgow.ac.uk.
FAU - Manson, Jan
AU  - Manson J
AD  - Knowledge and Information, Healthcare Improvement Scotland, Glasgow, UK.
FAU - Govan, Lindsay
AU  - Govan L
AD  - Health Economics and Health Technology Assessment (HEHTA), Institute of Health 
      and Wellbeing, University of Glasgow, Glasgow, UK.
FAU - Harbour, Robin
AU  - Harbour R
AD  - Knowledge and Information, Healthcare Improvement Scotland, Glasgow, UK.
FAU - Bennison, Jenny
AU  - Bennison J
AD  - Scottish Intercollegiate Guideline Network (SIGN), NHS Education for Scotland, 
      Royal College of General Practitioners (Scotland), Mill Lane Surgery, Edinburgh, 
      UK.
FAU - Watson, Eleanor
AU  - Watson E
AD  - Department of gastroenterology, Royal Infirmary of Edinburgh, NHS Lothian, 
      Edinburgh, UK.
FAU - Wu, Olivia
AU  - Wu O
AD  - Health Economics and Health Technology Assessment (HEHTA), Institute of Health 
      and Wellbeing, University of Glasgow, Glasgow, UK.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20160726
PL  - England
TA  - BMC Gastroenterol
JT  - BMC gastroenterology
JID - 100968547
RN  - 0 (Antacids)
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
RN  - U015TT5I8H (Bismuth)
SB  - IM
MH  - Antacids/therapeutic use
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Bismuth/therapeutic use
MH  - Drug Therapy, Combination
MH  - Helicobacter Infections/*drug therapy
MH  - *Helicobacter pylori
MH  - Histamine H2 Antagonists/therapeutic use
MH  - Humans
MH  - Network Meta-Analysis
MH  - Practice Guidelines as Topic
MH  - Proton Pump Inhibitors/*therapeutic use
PMC - PMC4962503
OTO - NOTNLM
OT  - Eradication
OT  - Helicobacter pylori
OT  - Network meta-analysis
OT  - Systematic review
EDAT- 2016/07/28 06:00
MHDA- 2017/02/01 06:00
PMCR- 2016/07/26
CRDT- 2016/07/28 06:00
PHST- 2015/12/10 00:00 [received]
PHST- 2016/07/14 00:00 [accepted]
PHST- 2016/07/28 06:00 [entrez]
PHST- 2016/07/28 06:00 [pubmed]
PHST- 2017/02/01 06:00 [medline]
PHST- 2016/07/26 00:00 [pmc-release]
AID - 10.1186/s12876-016-0491-7 [pii]
AID - 491 [pii]
AID - 10.1186/s12876-016-0491-7 [doi]
PST - epublish
SO  - BMC Gastroenterol. 2016 Jul 26;16(1):80. doi: 10.1186/s12876-016-0491-7.