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Review
. 2016 Jul;9(4):437-48.
doi: 10.1177/1756283X15621229. Epub 2015 Dec 16.

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Ignasi Puig  1 , Sheila López-Góngora  2 , Xavier Calvet  3 , Albert Villoria  4 , Mireia Baylina  2 , Jordi Sanchez-Delgado  4 , David Suarez  5 , Victor García-Hernando  4 , Javier P Gisbert  6
Affiliations
Review

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Ignasi Puig et al. Therap Adv Gastroenterol. 2016 Jul.

Abstract

Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy.

Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed.

Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second- and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and per-protocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I(2) : 92%) and 80% (95% confidence interval 71-90%; I(2) : 80%), respectively.

Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

Keywords: Helicobacter pylori; susceptibility-guided treatment; tailored treatment; third-line treatment.

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Conflict of interest statement

Conflict of interest statement: Xavier Calvet has served on advisory boards or received research grants or fees for educational activities from Pfizer, MSD and Abbvie; research grants from Janssen-Cilag; and served as an advisor and received fees for educational activities from Shire. There are no conflicts of interest related to the content of the present article. Albert Villoria has received fees for educational activities from MSD and Abbvie. There are no conflicts of interest related to the content of the present article. Sheila López-Góngora, Ignasi Puig, Mireia Baylina, David Suarez, Victor García-Hernando and Javier P. Gisbert have no relevant conflicts of interest to report. Writing support was provided by Michael Maudsley and funded by CIBERehd.

Figures

Figure 1.
Figure 1.
Flow of information through the various phases of the selection of the studies.
Figure 2.
Figure 2.
Risk of bias of the studies included in the qualitative analysis.
See this image and copyright information in PMC

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