Korean J Gastroenterol.  2013 Nov;62(5):267-271. 10.4166/kjg.2013.62.5.267.

Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy for Helicobacter pylori Infection in Korea

• Chung JW
• Ha M
• Yun SC
• Kim JH
• Lee JJ
• Kim YJ
• Kim KO
• Kwon KA
• Park DK
• Lee DH

• KMID: 1775733
• DOI: http://doi.org/10.4166/kjg.2013.62.5.267

Abstract

BACKGROUND/AIMS
Conventional triple therapy (CT) for Helicobacter pylori infection fails in up to one-third of patients. Sequential therapy (ST) seem be more effective than CT in other countries. However, there is no systemic literature review that directly compares CT and ST in Korea. The aim of this study was to compare ST with CT for H. pylori infection in Korea.
METHODS
Six randomized, prospective controlled trials were used to compare 10-day ST and 7- to 14-day CT in treatment-naive patients with documented H. pylori infection in Korea. Pooled eradication rates and OR with 95% CI were calculated.
RESULTS
The intention-to-treat eradication rates of H. pylori involving 1,529 patients were 79.7% (95% CI, 76.8-82.5%) for ST (n=754) and 68.1% (95% CI, 64.8-71.4%) for CT (n=775) (OR, 1.838; p<0.001). The per-protocol eradication rate of H. pylori involving 1,366 patients was 86.4% (95% CI, 83.3-88.5%) for ST (n=682) and 76.0% (95% CI, 72.8-79.2%) for CT (n=684) (OR, 1.974; p<0.001).
CONCLUSIONS
Ten-day ST was superior to CT in terms of eradicating H. pylori infection. Therefore, ST should be considered as a first-line therapy in Korea. However, ST did not achieve a sufficient eradication rate. More effective therapy should be developed.

Keyword

Helicobacter pylori; Sequential therapy; Meta-analysis

MeSH Terms

Anti-Bacterial Agents/*therapeutic use
Databases, Factual
Drug Therapy, Combination
Helicobacter Infections/*drug therapy
*Helicobacter pylori
Humans
Odds Ratio
Prospective Studies
Republic of Korea
Treatment Outcome
Anti-Bacterial Agents

Figure

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  Fig. 1. Forest plot treated with sequential or triple therapy for intention-to-treat (ITT) eradication rate. ST, sequential therapy; CT, conventional triple therapy.

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  Fig. 2. Forest plot treated with sequential or triple therapy for per-protocol (PP) eradication rate. ST, sequential therapy; CT, conventional triple therapy.

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  Fig. 3. Funnel plot of studies.

Reference

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