Journal List > Korean J Gastroenterol > v.62(5) > 1007155

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Chung, Ha, Yun, Kim, Lee, Kim, Kim, Kwon, Park, and Lee: Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy for Helicobacter pylori Infection in Korea
Original Article

Korean J Gastroenterol 2013;62(5):267-271.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.5.267

Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy for Helicobacter pylori Infection in Korea

Jun-Won Chung, Minsu Ha, Sung-Cheol Yun1, Jung Ho Kim, Jong Jun Lee, Yoon Jae Kim, Kyoung Oh Kim, Kwang An Kwon, Dong Kyun Park, Dong Ho Lee2

Department of Internal Medicine, Gil Medical Center, Gachon Graduate School of Medicine, Incheon, Korea

1Department of Clinical Epidemiology, Asan Medical Center, Seoul, Korea

2Department 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

Received 8 July 2013       Revised 21 August 2013       Accepted 21 August 2013

Copyright © 2013 Korean Ophthalmological Society

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.

Keywords: Helicobacter pylori, Sequential therapy, Meta-analysis

References

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Fig. 1.
Forest plot treated with sequential or triple therapy for intention-to-treat (ITT) eradication rate. ST, sequential therapy; CT, conventional triple therapy.
kjg-62-267f1.tif
Fig. 2.
Forest plot treated with sequential or triple therapy for per-protocol (PP) eradication rate. ST, sequential therapy; CT, conventional triple therapy.
kjg-62-267f2.tif
Fig. 3.
Funnel plot of studies.
kjg-62-267f3.tif
Table 1.
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.

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