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A 10- or 14-day Bismuth-containing Quadruple Therapy as a First-line Helicobacter pylori Eradication Therapy: A Systematic Review and Meta-analysis

김성은, 정혜경, 강승주, 이용찬, 양효준, 박선영, 신철민, 임현철, 김지현, 남수연, 신운건, 박재명, 최일주, 김재규, 최미영,
소속 상세정보
김성은 ( Kim Sung-Eun ) - Kosin University College of Medicine Department of Internal Medicine
정혜경 ( Jung Hye-Kyung ) - Ewha Womans University School of Medicine Department of Internal Medicine
강승주 ( Kang Seung-Joo ) - Seoul National University Hospital Gangnam Center Department of Internal Medicine
이용찬 ( Lee Yong-Chan ) - Yonsei University College of Medicine Department of Internal Medicine
양효준 ( Yang Hyo-Joon ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Internal Medicine
박선영 ( Park Seon-Young ) - Chonnam National University Medical School Department of Internal Medicine
신철민 ( Shin Cheol-Min ) - Seoul National University Bundang Hospital Department of Internal Medicine
임현철 ( Lim Hyun-Chul ) - Yonsei University College of Medicine Yongin Severance Hospital Department of Internal Medicine
김지현 ( Kim Jie-Hyun ) - Yonsei University College of Medicine Department of Internal Medicine
남수연 ( Nam Su-Youn ) - Kyungpook National University School of Medicine Department of Gastroenterology
신운건 ( Shin Woon-Geon ) - Hallym University College of Medicine Department of Internal Medicine
박재명 ( Park Jae-Myung ) - Catholic University Seoul St. Mary’s Hospital Department of Internal Medicine
최일주 ( Choi Il-Ju ) - National Cancer Center Center for Gastric Cancer
김재규 ( Kim Jae-Gyu ) - Chung-Ang University College of Medicine Department of Internal Medicine
최미영 ( Choi Mi-Young ) - National Evidence-Based Healthcare Collaborating Agency

Abstract


Background/Aims: The eradication rate of the first-line standard triple therapy (STT) for Helicobacter pylori (H. pylori) infection has decreased since 2000; therefore, other first-line therapies are required. This study was aimed at investigating the efficacy of bismuth-containing quadruple therapy (PBMT) for first-line H. pylori eradication compared to STT, sequential therapy (SQT), and concomitant therapy (CT).

Materials and Methods: The Ovid-MEDLINE, Koreamed, EMBASE, KMBASE, and Cochrane Library databases were searched from January 2008 to July 2018. All identified randomized controlled trials (RCTs) comparing PBMT and non-PBMT for first-line H. pylori eradication therapy were included in the final analysis.

Results: A total of 3,653 patients from seven RCTs were enrolled. The pooled eradication rates of PBMT by intention-to-treat (ITT) and per-protocol (PP) analyses were 82.1% (95% CI, 68.2~90.8%) and 88.8% (95% CI, 77.1~94.9%), respectively. However, no statistically significant difference was observed in eradication rates of the 10- or 14-day PBMT as compared to 14-day STT, 10-day SQT, and 10-day CT in ITT and PP analyses. PBMT was significantly higher in adverse events than in the other eradication regimens (RR, 1.64; 95% CI, 1.11~2.44). Considerable heterogeneity in adverse events was observed among studies (χ2=88.7; P<0.001, I2=93%).

Conclusions: PBMT can be the first-line treatment for H. pylori eradication in Korea when other first-line options, including STT, SQT, or CT, are unavailable due to their high adverse event rates.

키워드

Adverse effects; Bismuth tripotassium dicitrate; Disease eradication; Helicobacter pylori; Meta-analysis

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