Evaluation of treatment regimens to cure Helicobacter pylori infection - ameta-analysis

Objective: To assess effectiveness of treatment to cure Helicobacter pylori infection. Data Synthesis: Meta-analysis of 666 manuscripts (full papers, abstracts, l etters to the editor) identified through Medline and a manual search (1986 to January 1998), Data were overviewed by regression analysis with weighted random effects models. Subjects: 53 228 patients with H. pylori infection. Interventions: Patients were treated with 132 different medication combinat ions. Main outcome measure: Cure of H. pylori infection per protocol and intentio n-to-treat basis at least 28 days after treatment. Results: The nationality of the patients and therapeutic regimen have a sig nificant impact on the results, after correction for the heterogeneity in t he precision of the cure rate caused by different study sizes and random ef fect for study. On the basis of the original sample size, cure rates of 80- 85% were achieved using combinations of a proton-pump inhibitor or ranitidi ne bismuth citrate with two antibiotics including clarithromycin, amoxycill in and metronidazole or tinidazole, Comparable cure rates were also achieve d using a combination of a proton-pump inhibitor or Hz-receptor antagonist with bismuth subcitrate or tripotassium dicitrato bismuthate, metronidazole and tetracycline, The dose of clarithromycin influenced cure rates, Treatm ent duration did not influence the outcome. Conclusion: Several therapeutic regimens are eligible to cure H. pylori inf ection. However, none of the medication combinations were able to cure H. p ylori infection in more than 85% of the patients assessed by intention-to-t reat. The countries in which the studies were performed also had a signific ant impact on eradication rates.