KjG The Korean Journal of Gastroenterology Korean J Gastroenterol 1598-9992 2233-6869 Korean Society of Gastroenterology 10.4166/kjg.2013.62.5.267 kjg-62-267 Original Article Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy for Helicobacter pylori Infection in Korea ChungJun-Won HaMinsu YunSung-Cheol 1 KimJung Ho LeeJong Jun KimYoon Jae KimKyoung Oh KwonKwang An ParkDong Kyun LeeDong Ho 2 Department of Internal Medicine, Gil Medical Center, Gachon Graduate School of Medicine, Incheon, Korea Department of Clinical Epidemiology, Asan Medical Center, Seoul, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Correspondence to: Dong Ho Lee, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-31-787-7006, Fax: +82-31-787-4051, E-mail: dhljohn@yahoo.co.kr 10 2013 04 10 2013 625 267 271 08072013 21082013 21082013 Copyright © 2013 Korean Ophthalmological Society 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 treatmentnaive 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.

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

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

Funnel plot of studies.

Studies of the Efficacy of Sequential Therapy for Treatment of Helicobacter pylori Infection

Study, year Diagnostic tool for H. pylori infection Tests for confirmation of eradication Number, regimen
 PPI Patients Jadad score
ST CT
Choi et al., 200813 Not mentioned UBT or RUT and histology 77, 10 days 81, 10 days Omeprazole PUD and others 2
Kim et al., 201111 UBT, RUT, histology UBT 205, 10 days 205, 14 days Pantoprazole PUD, NUD and others 3
Park et al., 201212 Positive on 2 of 3 tests RUT, histology, and UBT UBT 162, 10 days 164, 7 days Rabeprazole PUD and others 3
Oh et al., 201214 RUT, histology UBT 92, 10 days 82, 7 days Rabeprazole PUD and others 3
Choi et al., 201215 UBT, RUT, histology UBT, histology 87, 10 days 86, 7‐14 days Rabeprazole PUD and others 2
Chung et al., 201216 Positive on 2 of 3 tests: RUT, histology, and culture UBT 79, 10 days 80, 10 days Lansoprazole PUD 3

Study design is open labeled. ST, sequential therapy; CT, conventional triple therapy; PPI, proton pump inhibitor; UBT, urea breath test; RUT, rapid urease test; PUD, peptic ulcer disease; NUD, non-ulcer dyspepsia.