Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic Review and Meta-Analysis

Joon Sung Kim, Byung-Wook Kim, Joo Ho Ham, Hyung Wook Park, Yun Kyeong Kim, Min Young Lee, Jeong-Seon Ji, Bo-In Lee, Hwang Choi, Joon Sung Kim, Byung-Wook Kim, Joo Ho Ham, Hyung Wook Park, Yun Kyeong Kim, Min Young Lee, Jeong-Seon Ji, Bo-In Lee, Hwang Choi

Abstract

Background/aims: Sequential therapy (ST) for Helicobacter pylori infection in countries other than Korea has shown higher eradication rates than triple therapy (TT). The aim of this study was to evaluate the efficacy of ST in Korea by performing a meta-analysis.

Methods: We performed a comprehensive literature search on the efficacy of ST as a first-line therapy. The odds ratios (ORs) of eradicating H. pylori infection after ST compared with TT were pooled. Pooled estimates of the eradication rates of ST and TT were also calculated.

Results: A total of six studies provided data on 1,759 adult patients. The ORs for the intention to treat (ITT) and the per-protocol (PP) eradication rate were 1.761 (95% confidence interval [CI], 1.403 to 2.209) and 1.966 (95% CI, 1.489 to 2.595). Pooled estimates of the ITT and PP eradication rate were 79.4% (95% CI, 76.3% to 82.2%) and 86.4% (95% CI, 83.5% to 88.8%), respectively, for the ST group, and 68.2% (95% CI, 62.1% to 73.8%) and 78.9% (95% CI, 68.9% to 81.7%), respectively, for the TT group.

Conclusions: Although ST presented a higher eradication rate than TT in Korea, the pooled eradication rates were lower than expected. Further studies are needed to validate ST as a first-line treatment for H. pylori in Korea.

Keywords: Eradication; Helicobacter pylori; Meta-analysis.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flow diagram of studies included in this meta-analysis.
Fig. 2
Fig. 2
Forest plot of the intention-to-treat analysis of sequential therapy (ST) compared with triple therapy (TT). CI, confidence interval.
Fig. 3
Fig. 3
Forrest plot of the per-protocol analysis of sequential therapy (ST) compared with triple therapy (TT). CI, confidence interval.
Fig. 4
Fig. 4
Forrest plot of the adverse events associated with sequential therapy (ST) compared with triple therapy (TT). CI, confidence interval.
Fig. 5
Fig. 5
Funnel plot asymmetry test for the detection of bias within the studies for the eradication rate of sequential therapy compared with triple therapy.

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