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First-line therapies for H. pylori infection in Italy: a pooled-data analysis

Ahead of print available from 04/02/2022
These articles are scheduled for publication in Vol. 85 (2) 2021

Author(s) V. De Francesco 1, A. Zullo 2, R. Manta 3, M. Pavoni 4, IM. Saracino 4, G. Fiorini 4, F. Giostra 5, G. Monti 5, D. Vaira 4
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DOI10.51821/85.2.9680
Affiliations:
(1) Gastroenterology Unit, ‘Riuniti’ Hospital, Foggia, Italy
(2) Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
(3) Gastroenterology and Digestive Endoscopy, ‘Generale’ Hospital, Perugia, Italy
(4) Dept. of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologne, Bologne, Italy
(5) Dept. of Medical and Surgical Sciences, University of Bologne; Bologne, Italy

Background: Curing H. pylori infection remains challenging, and the use of most effective first-line therapy represents a therapeutic cornerstone. To monitor the efficacy of first-line therapies in Italy, we designed a systematic review with pooleddata analysis of data published in the last 15 years.

Methods: The search was focused on standard regimens and adult patients. Studies that included modified therapy regimens, pediatric patients, case series with less than 5 patients, and those in language other than English were excluded.

Results: A total of 40 studies, with 74 therapeutic arms and 13,539 patients were evaluated. Among the 14-day triple therapies, the combination with proton pump inhibitor (PPI), clarithromycin and amoxicillin achieved the highest (77.9%) success rate, whilst the lowest success rate (62.7%) was observed following the 14-day PPI, clarithromycin and tinidazole regimen. The overall efficacy of triple therapies significantly decreased from 75.7% to 72.1% in the last decade. Sequential (88.3% on 3431 patients), concomitant (88.8% on 376 patients), and the bismuth-based quadruple therapy with three-in-one capsule, containing bismuth subcitrate potassium (140 mg), metronidazole (125 mg), tetracycline (125 mg) (90.4% on 999 patients) achieved similarly high eradication rates, but data on concomitant are still limited. The bismuth-based was associated with the higher (42.7%) incidence of side-effects.

Conclusions: Data found that all triple therapies, irrespective of drug combination and therapy duration, should be abandoned in Italy due to their unacceptable low success rates. Monitoring the efficacy of standard first-line therapies in other countries could be clinically useful for both patients and clinicians.

Keywords: Helicobacter pylor, first-line therapy, treatment, antibiotic, therapy regimens
The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.