Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jun;33(6):454-462.
doi: 10.5152/tjg.2022.21579.

High-Dose Dual Therapy Versus Bismuth-Containing Quadruple Therapy for the Treatment of Helicobacter pylori Infection: A Systematic Review with Meta-Analysis

Zhikun Yin  1 , Ji Li  2 , Weifeng Huang  2 , Xiaoyi Lei  1 , Dong Xu  2 , Guihua Xu  2 , Hua Li  2 , Jinyan Zhang  1
Affiliations
Meta-Analysis

High-Dose Dual Therapy Versus Bismuth-Containing Quadruple Therapy for the Treatment of Helicobacter pylori Infection: A Systematic Review with Meta-Analysis

Zhikun Yin et al. Turk J Gastroenterol. 2022 Jun.

Abstract

Background: This study aimed to evaluate the efficacy and safety of high-dose dual therapy for Helicobacter pylori (H. pylori) eradication compared to bismuth-containing quadruple therapy.

Methods: The electronic database of PubMed, Embase, and Cochrane Library were searched from inception to March 18, 2021. Randomized, controlled trials that evaluated high-dose dual therapy versus bismuth-containing quadruple therapy for H. pylori infection were included.

Results: We included 6 studies containing 1677 patients with H. pylori infection. This meta-analysis demonstrated that high-dose dual therapy achieved similar eradication rate compared with bismuth-containing quadruple therapy (intention-to-treat: 84.6% vs 83.7%, relative risk (RR) = 1.01, 95% CI: 0.97-1.06, P = .49; per-protocol = 88.4% vs 89.0%, RR = 1.00, 95% CI: 0.97-1.04, P = .99). However, highdose dual therapy showed fewer side effects (13.1% vs 32.0%, RR = 0.51, 95% CI: 0.34-0.78, P = .002) and better compliance (96.1% vs 93.3%, RR = 1.03, 95% CI: 1.00-1.05, P = .03) compared to bismuth-containing quadruple therapy.

Conclusion: This meta-analysis demonstrated that high-dose dual therapy is equally effective with bismuth-containing quadruple therapy in eradicating H. pylori, with fewer side effects and better compliance.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of selection.
Figure 2.
Figure 2.
Risk of bias graph.
Figure 3.
Figure 3.
Risk of bias summary.
Figure 4.
Figure 4.
Forest plot of the efficacy of HDDT versus control regimens according to intention-to-treat analysis. HDDT, high-dose dual therapy.
Figure 5.
Figure 5.
Forest plot of the efficacy of HDDT versus control regimens according to per-protocol analysis. HDDT, high-dose dual therapy.
Figure 6.
Figure 6.
Forest plot of side effects of HDDT versus control regimens. HDDT, high-dose dual therapy.
Figure 7.
Figure 7.
Forest plot of compliance of HDDT versus control regimens. HDDT, high-dose dual therapy.
Figure 8.
Figure 8.
Publication bias.
Figure 9
Figure 9
.We calculated a diversity-adjusted required information size of 1331 participants using α = 0.05 (two-sided), β = 0.20 (power = 80%), a relative risk reduction of 10% and a proportion of 83.7% in the control group. The cumulative z-curve (blue line) was constructed using a fixed-effects model. The cumulative Z-curve (blue line) did not cross the conventional boundary or trial sequential monitoring boundary, but crossed the futility boundary and reached the required information size (vertical red line), suggesting that the efficacy of HDDT was equal to that of BQT. HDDT, high dose dual therapy. BQT, bismuth-containing quadruple therapy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zamani M, Ebrahimtabar F, Zamani V.et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018;47(7):868–876.. 10.1111/apt.14561) - DOI - PubMed
    1. Malfertheiner P, Megraud F, O'Morain CA.et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6–30.. 10.1136/gutjnl-2016-312288) - DOI - PubMed
    1. Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology. 2018;155(5):1372-1382.e17. 10.1053/j.gastro.2018.07.007) - DOI - PMC - PubMed
    1. Graham DY, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy. Helicobacter. 2007;12(4):275–278.. 10.1111/j.1523-5378.2007.00518.x) - DOI - PubMed
    1. Mégraud F.H pylori antibiotic resistance: prevalence, importance, and advances in testing. Gut. 2004;53(9):1374–1384.. 10.1136/gut.2003.022111) - DOI - PMC - PubMed