Pooled analysis on the efficacy of the second-line treatment regimens for Helicobacter pylori infection

Background: Although many of the currently available Helicobacter pylori er adication regimens fail to cure 5%-12% of patients, an optimal re-treatment therapy for eradication-failure patients has still not been established. T he aim of this study was to examine all reports concerning the efficacy of re-eradication regimens for H. pylori infection, and to establish optimal r e-eradication regimens. Methods: Studies concerning re-eradication regimens were retrieved from the MEDLINE database, reference lists and major congre ss abstract lists UP through December 1999. Data from all selected reports were pooled into several groups depending on second-line or initial therapi es. Pooled eradication rates of re-treatment regimens were compared using F isher's exact test (P < 0.05). Results: Sixteen articles and 24 abstracts w ith 75 total treatment arms were included in this study. Pooled re-eradicat ion rates by proton-pump inhibitor (PPI)-based dual therapy. PPI-based trip le therapy, ranitidine bismuth-based triple therapy and quadruple therapy w ere 45.8%, 69.8%, 80.2% and 75.8%, respectively. Eradication rates from stu dies with two new antimicobials added were higher than rates from studies w ith only one new antimicrobial added (P=0.0064). Conclusion: Ranitidine bis muth-based triple therapies, as well as quadruple therapies, seem to be the most effective re-treatment therapies in ail currently undertaken therapie s. The strategy of adding two new antimicrobials to previous regimens was a lso effective in re-eradication therapy.