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Helicobacter 2024Recently, vonoprazan-amoxicillin (VA) dual therapy has been reported as a promising approach for Helicobacter pylori (H. pylori) eradication. However, the effects of VA... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Recently, vonoprazan-amoxicillin (VA) dual therapy has been reported as a promising approach for Helicobacter pylori (H. pylori) eradication. However, the effects of VA therapy versus bismuth-containing quadruple therapy (BQT) on H. pylori eradication remains unclear. The objective of this meta-analysis was to compare the effects of VA dual therapy with BQT for H. pylori eradication.
METHODS
A comprehensive search of the literature was conducted from the beginning to September 2023, utilizing PubMed, Embase, the Cochrane Library and Web of Science database. A random-effects model was used to perform a meta-analysis to determine the pooled relative risk (RR) with 95% confidence intervals (CIs). Moreover, trial sequential analysis (TSA) was conducted to evaluate the conclusiveness of the H. pylori eradication rate.
RESULTS
Six randomized controlled trials (RCTs) with 1233 patients were included. The VA therapy has similar eradication rate (ITT analysis: 87% vs. 85.7%, RR = 1.01, 95% CI: 0.93-1.09, p = 0.84; PP analysis: 92.5% vs. 93.2%, RR = 1.00, 95% CI: 0.94-1.06, p = 0.97) and compliance (RR = 1.01, 95% CI: 0.99-1.03, p = 0.32) compared to BQT. The VA therapy group had a significantly lower incidence of total adverse events than the BQT group (16.3% vs. 40.0%, RR = 0.45, 95% CI: 0.37-0.55, p < 0.00001). The TSA result showed that the effect was conclusive.
CONCLUSIONS
Current evidence indicated that VA therapy is just as successful as BQT in eliminating H. pylori, yet it has fewer adverse events and similar compliance.
Topics: Humans; Amoxicillin; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome; Sulfonamides
PubMed: 37983865
DOI: 10.1111/hel.13040 -
CMAJ : Canadian Medical Association... Feb 2011Observational studies and randomized controlled trials have yielded inconsistent findings about the association between the use of acid-suppressive drugs and the risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Observational studies and randomized controlled trials have yielded inconsistent findings about the association between the use of acid-suppressive drugs and the risk of pneumonia. We performed a systematic review and meta-analysis to summarize this association.
METHODS
We searched three electronic databases (MEDLINE [PubMed], Embase and the Cochrane Library) from inception to Aug. 28, 2009. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect.
RESULTS
We identified 31 studies: five case-control studies, three cohort studies and 23 randomized controlled trials. A meta-analysis of the eight observational studies showed that the overall risk of pneumonia was higher among people using proton pump inhibitors (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11-1.46, I(2) 90.5%) and histamine(2) receptor antagonists (adjusted OR 1.22, 95% CI 1.09-1.36, I(2) 0.0%). In the randomized controlled trials, use of histamine(2) receptor antagonists was associated with an elevated risk of hospital-acquired pneumonia (relative risk 1.22, 95% CI 1.01-1.48, I(2) 30.6%).
INTERPRETATION
Use of a proton pump inhibitor or histamine(2) receptor antagonist may be associated with an increased risk of both community- and hospital-acquired pneumonia. Given these potential adverse effects, clinicians should use caution in prescribing acid-suppressive drugs for patients at risk.
Topics: Antacids; Anti-Ulcer Agents; Community-Acquired Infections; Cross Infection; Dose-Response Relationship, Drug; Histamine H2 Antagonists; Humans; Pneumonia; Proton Pump Inhibitors
PubMed: 21173070
DOI: 10.1503/cmaj.092129 -
The Journal of International Medical... Oct 2023We performed a meta-analysis to determine whether the addition of probiotics to the bismuth quadruple therapy (BQT) for would improve the incidence of eradication and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We performed a meta-analysis to determine whether the addition of probiotics to the bismuth quadruple therapy (BQT) for would improve the incidence of eradication and reduce that of side effects.
METHODS
Randomized controlled trials matching the inclusion criteria were collected from PubMed, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials. A Mantel-Haenszel random-effects model was used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs) for the incidences of eradication rate, side effects as a whole, diarrhea, and other side effects.
RESULTS
Ten studies were selected for inclusion in the meta-analysis. The pooled RRs for the eradication rates in intention-to-treat and per-protocol analyses of the probiotic group . the control group were 1.07 (95% CI: 1.02-1.11) and 1.04 (95% CI: 1.00-1.07), respectively. Probiotic supplementation reduced the incidences of side effects (RR 0.58, 95% CI: 0.37-0.91), diarrhea (RR 0.41, 95% CI: 0.25-0.67), and bitter taste (RR 0.63, 95% CI: 0.40-0.99).
CONCLUSIONS
The results of this meta-analysis support the use of probiotics in combination with BQT in the clinical management of patients with infection.
Topics: Humans; Helicobacter Infections; Bismuth; Helicobacter pylori; Anti-Bacterial Agents; Drug Therapy, Combination; Dietary Supplements; Probiotics; Diarrhea; Treatment Outcome
PubMed: 37848344
DOI: 10.1177/03000605231203841 -
Helicobacter Apr 2015To assess the efficacy and safety of hybrid therapy compared to other pre-existing therapies and to new therapies. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the efficacy and safety of hybrid therapy compared to other pre-existing therapies and to new therapies.
METHODS
Through a search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Conference Proceedings Citation Index, two independent reviewers systemically identified randomized, controlled trials that compared hybrid therapy to other pre-existing and new therapies. Dichotomous data were pooled to obtain the relative risk (RR) of the eradication rate, with 95% confidence intervals (CIs).
RESULTS
We identified 6 studies, 5 of which compared hybrid therapy and sequential therapy, and 3 of which compared hybrid therapy and concomitant therapy. Pooled estimates of the 5 randomized controlled trials (RCTs) revealed no significant differences between hybrid therapy and sequential therapy and no evidence of heterogeneity (I(2) = 0%; p = .803), the pooled RRs were 1.02 (95% CI: 0.93-1.12) (intention-to-treat (ITT)), and 1.03 (95% CI: 0.94-1.13) (per protocol (PP)). Pooled estimates of the 3 RCTs showed no significant differences between hybrid therapy and concomitant therapy with no evidence of heterogeneity (I(2) = 0%; p = .967), the pooled RRs were 0.99 (95% CI: 0.89-1.10) (ITT) and 0.99 (95% CI: 0.89-1.10) (PP). No significant differences in adverse events were noted among hybrid therapy, sequential therapy, and concomitant therapy ((RR: 1.13; 95% CI: 0.87-1.48; I(2) = 13.2%; p = .327), (RR: 0.89; 95% CI: 0.73-1.08; I(2) = 0%; p = .978) (ITT), respectively). After consideration of all treatment arms, the ITT eradication rates with hybrid therapy, concomitant therapy, and sequential therapy were 88.6, 86.3, and 84.7%, respectively. And the PP eradication rates were 92.1, 92.5, and 87.5%. No significant differences were observed between the groups in terms of compliance.
CONCLUSIONS
All three of these therapies yielded good eradication rates. Hybrid therapy could be an alternative to sequential therapy and concomitant therapy, but additional RCTs are needed to confirm this finding.
Topics: Amoxicillin; Anti-Infective Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Helicobacter Infections; Humans; Metronidazole; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 25381839
DOI: 10.1111/hel.12180 -
Clinical and Experimental Medicine Aug 2023Helicobacter pylori (H. pylori) infection is a major cause of duodenal ulcers, gastric ulcers, and gastric cancer. However, the optimal duration for H. pylori... (Meta-Analysis)
Meta-Analysis Review
Helicobacter pylori (H. pylori) infection is a major cause of duodenal ulcers, gastric ulcers, and gastric cancer. However, the optimal duration for H. pylori eradication therapy remains controversial. Most studies have mainly focused on triple therapy, and there is insufficient research on bismuth-containing quadruple therapy. The aim of this study was to compare the clinical effect of the 10-day bismuth-containing quadruple treatment regimen with the 14-day regime in eradicating H. pylori. We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials published in English until May 2022 according to the eligibility criteria. Summary risk ratios (RRs) and 95% confidence intervals (CIs) for eradication rates, adverse effects, and compliance were calculated for included studies. Four studies, involving 1173 patients, were eligible for inclusion. The eradication rate was similar in the 10-day treatment group and the 14-day treatment group in the intention-to-treat analysis (RR 0.97, 95% CI 0.93 to 1.01). Meanwhile, the incidence of adverse effects was lower in patients who received 10 days of treatment than in those who received 14 days of treatment and patients' compliance was almost the same between two groups. Compared to the 14-day bismuth-containing quadruple regimens, 10-day regimens had similar efficacy and lower incidence of adverse effects. Therefore, the 10-day regimen is safe and well-tolerated and should be recommended for H. pylori infection.
Topics: Humans; Bismuth; Helicobacter pylori; Amoxicillin; Proton Pump Inhibitors; Drug Therapy, Combination; Helicobacter Infections; Anti-Bacterial Agents; Treatment Outcome
PubMed: 36538198
DOI: 10.1007/s10238-022-00953-7 -
The International Journal of... Jul 2010To compare the effects of food and antacids on the bioavailability of first-line anti-tuberculosis drugs. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the effects of food and antacids on the bioavailability of first-line anti-tuberculosis drugs.
METHOD
Systematic search of electronic databases PubMed (January 1950-May 2009), and the Cochrane Library database (January 1974-May 2009), including the Cochrane Centre register of controlled trials, and ongoing trials from research registers using key terms 'food', 'antacids', 'meal', 'controlled trial', 'diet', and the first-line anti-tuberculosis drugs isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide (PZA). Meta-analysis was performed using RevMan software 5 to assess the impact of food or antacids on the maximum plasma concentrations (C(max)) and area under the plasma concentration time curve (AUC) of anti-tuberculosis drugs.
RESULTS
Twelve trials involving 157 patients were included in the meta-analysis. The overall effects showed that food significantly reduced the C(max) mean difference (C(max) MD; C(max) MD -1.42, 95%CI -1.56--1.28, P < 0.00001) and AUC (C(max) MD -3.33, 95%CI -4.05--2.62, P < 0.00001) of INH but antacids did not. Food also significantly reduced the C(max) MD (C(max) MD -2.47, 95%CI -3.30--1.64, P < 0.00001) but not the AUC of RMP. Antacids had no effect on the C(max) MD or AUC of RMP. The C(max) and AUC of PZA were unaffected by both food and antacids. Both food and antacids reduced the C(max) but not the AUC of EMB.
CONCLUSION
From a pharmacokinetic point of view, it seems that the better option for patients with gastrointestinal upsets during chemotherapy would be to add antacids rather than dosing with meals.
Topics: Antacids; Antitubercular Agents; Area Under Curve; Biological Availability; Clinical Trials as Topic; Drug Interactions; Food-Drug Interactions; Humans
PubMed: 20550762
DOI: No ID Found -
Pediatrics Aug 2017Gastroesophageal reflux (GER) is defined as GER disease (GERD) when it leads to troublesome symptoms and/or complications. We hypothesized that definitions and outcome... (Review)
Review
CONTEXT
Gastroesophageal reflux (GER) is defined as GER disease (GERD) when it leads to troublesome symptoms and/or complications. We hypothesized that definitions and outcome measures in randomized controlled trials (RCTs) on pediatric GERD would be heterogeneous.
OBJECTIVES
Systematically assess definitions and outcome measures in RCTs in this population.
DATA SOURCES
Data were obtained through Cochrane, Embase, Medline, and Pubmed databases.
STUDY SELECTION
We selected English-written therapeutic RCTs concerning GERD in children 0 to 18 years old.
DATA EXTRACTION
Data were tabulated and presented descriptively. Each individual parameter or set of parameters with unique criteria for interpretation was considered a single definition for GER(D). Quality was assessed by using the Delphi score.
RESULTS
A total of 2410 unique articles were found; 46 articles were included. Twenty-six (57%) studies defined GER by using 25 different definitions and investigated 25 different interventions. GERD was defined in 21 (46%) studies, all using a unique definition and investigating a total of 23 interventions. Respectively 87 and 61 different primary outcome measures were reported by the studies in GER and GERD. Eight (17%) studies did not report on side effects. Of the remaining 38 (83%) studies that did report on side effects, 18 (47%) included this as predefined outcome measure of which 4 (22%) as a primary outcome measure. Sixteen studies (35%) were of good methodological quality.
LIMITATIONS
Only English-written studies were included.
CONCLUSIONS
Inconsistency and heterogeneity exist in definitions and outcome measures used in RCTs on pediatric GER and GERD; therefore, we recommend the development of a core outcome set.
Topics: Adolescent; Antacids; Child; Child, Preschool; Delphi Technique; Gastric Acidity Determination; Gastroesophageal Reflux; Gastroscopy; Humans; Infant; Infant, Newborn; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic
PubMed: 28751614
DOI: 10.1542/peds.2016-4166 -
Digestion 2016Since resistance of Helicobacter pylori is developing very fast all over the world, new treatment regimens for eradication are urgently needed. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Since resistance of Helicobacter pylori is developing very fast all over the world, new treatment regimens for eradication are urgently needed.
AIM
To compare eradication success rate of H. pylori treatment regimens with and without doxycycline.
METHODS
English medical literature searches were conducted for regimens including doxycycline for eradication of H. pylori. Searches were performed up to August 31, 2015, using MEDLINE, PubMed, EMBASE, Scopus and CENTRAL. Meta-analysis was performed by using comprehensive meta-analysis software. Pooled ORs and 95% CIs were calculated comparing treatment regimens for eradication of H. pylori infection with and without doxycycline.
RESULTS
The OR for eradication success rate in a fixed model was in favor for treatment regimens with doxycycline: 1.292, 95% CI 1.048-1.594, p = 0.016. There was no significant heterogeneity in the included studies: Q = 15.130, d.f. (Q) = 8, I2 = 47.126, p > 0.10. When treatment regimens with doxycycline were compared only with treatment regimens with tetracycline, no significant difference was found in eradication success rate: OR 0.95, 95% CI 0.68-1.32, p = 0.77. But when treatment regimens with doxycycline were compared with treatment regimens without tetracycline, the OR in favor of doxycycline was even higher: OR 1.59, 95% CI 1.21-2.09, p < 0.001.
CONCLUSION
In this meta-analysis, we confirmed doxycycline efficiency in the eradication of H. pylori. Thus, triple, quadruple or even high dose dual therapy with regimens containing doxycycline should be considered.
Topics: Amoxicillin; Antacids; Anti-Bacterial Agents; Clarithromycin; Doxycycline; Drug Therapy, Combination; Esomeprazole; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Lansoprazole; Metronidazole; Proton Pump Inhibitors; Ranitidine; Tetracycline
PubMed: 26849820
DOI: 10.1159/000443683 -
Alimentary Pharmacology & Therapeutics Jan 2006A quadruple therapy has been generally recommended as rescue regimen for Helicobacter pylori eradication failures. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A quadruple therapy has been generally recommended as rescue regimen for Helicobacter pylori eradication failures.
AIMS
To systematically review the efficacy and tolerance of levofloxacin-based rescue regimens, and to conduct a meta-analysis of studies comparing these regimens with quadruple therapy for H. pylori eradication failures.
METHODS
Selection of studies -- levofloxacin-based rescue regimens. For the meta-analysis, randomized-controlled trials comparing levofloxacin-based and quadruple regimens. Search strategy -- electronic and manual. Assessment of study quality -- independently by two reviewers. Data synthesis --'intention-to-treat' eradication rate.
RESULTS
Mean eradication rate with levofloxacin-based regimens was 80%. Ten-day regimens were more effective than 7-day combinations (81% vs. 73%; P < 0.01). The meta-analysis showed better results with levofloxacin than with the quadruple combination (81% vs. 70%; OR = 1.80; 95% CI = 0.94-3.46). This difference reached statistical significance and heterogeneity markedly decreased when a single outlier study was excluded or when only high-quality studies were considered. Meta-analysis showed less adverse effects with levofloxacin than with quadruple regimen, both overall (19% vs. 44%; OR = 0.27; 95% CI = 0.16-0.46) and regarding severe adverse effects (0.8% vs. 8.4%; OR = 0.20; 95% CI =0.06-0.67).
CONCLUSIONS
After H. pylori eradication failure, levofloxacin-based rescue regimen is more effective and better tolerated than the generally recommended quadruple therapy. A 10-day combination of levofloxacin-amoxicillin-proton pump inhibitor constitutes an encouraging second-line alternative.
Topics: Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Ofloxacin; Treatment Failure
PubMed: 16393278
DOI: 10.1111/j.1365-2036.2006.02737.x -
Internal Medicine Journal Apr 2015Vitamin B12 (cobalamin) deficiency can result in irreversible structural brain changes if not treated appropriately. Long-term use of acid-lowering agents (ALA) has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vitamin B12 (cobalamin) deficiency can result in irreversible structural brain changes if not treated appropriately. Long-term use of acid-lowering agents (ALA) has been linked to vitamin B12 deficiency, but results are inconsistent.
AIM
To evaluate the association between prolonged ALA use and vitamin B12 deficiency by performing a meta-analysis.
METHODS
A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents, Cochrane Library, Google Scholar, Science Direct and Web of Science. Original data were abstracted from each study and used to calculate a pooled odds ratio and 95% confidence interval (95% CI).
RESULTS
Of the articles reviewed, four case-control studies (4254 cases and 19,228 controls) and one observational study met full criteria for analysis. The long-term ALA use was significantly associated with development of vitamin B12 deficiency (hazard ratio 1.83, 95% CI: 1.36-2.46, P-value 0.00).
CONCLUSION
Chronic use of ALA is a risk factor for developing vitamin B12 deficiency. Judicious prescribing of ALA and regular monitoring of vitamin B12 in patients who are inevitably on long-term ALA therapy are recommended.
Topics: Antacids; Case-Control Studies; Gastroesophageal Reflux; Humans; Vitamin B 12 Deficiency
PubMed: 25583062
DOI: 10.1111/imj.12697