依据药物敏感试验根除幽门螺杆菌的临床疗效随访

Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Background

Treating Helicobacter pylori infection according to antibiotic resistance has been frequently recommended. However, information on its real effectiveness is scarce.

Aim

The aim of this study is to perform a meta-analysis comparing empirical vs. susceptibility-guided treatment of H. pylori.

Methods

Selection of studies: Studies comparing empirical versus susceptibility-guided treatment were selected. Search strategy: electronic and manual up to August 2021. Data synthesis: by intention-to-treat (random-effects model).

Results

Overall, 54 studies were included (6,705 patients in the susceptibility-guided group and 7,895 in the empirical group). H. pylori eradication rate was 86 vs. 76%, respectively (RR: 1.12; 95% CI: 1.08-1.17; I 2: 83%). Similar results were found when only RCTs were evaluated (24 studies; RR: 1.16; 95% CI: 1.11-1.22; I 2: 71%) and when susceptibility testing was assessed by culture (RR: 1.12; 95% CI: 1.06-1.18) or PCR (RR: 1.14; 95% CI: 1.05-1.23). For first-line treatments (naïve patients; 30 studies), better efficacy results were obtained with the susceptibility-guided strategy (RR: 1.15; 95% CI: 1.11-1.20; I 2: 79%). However, for empirical first-line quadruple regimens, in particular (both with and without bismuth, excluding the suboptimal triple therapies), not based on CYP2C19 gene polymorphism, no differences in efficacy were found compared with the susceptibility-guided group (RR: 1.04; 95% CI: 0.99-1.09); this lack of difference was confirmed in RCTs (RR: 1.05; 95% CI: 0.99-1.12). For rescue therapies (13 studies, most 2nd-line), similar results were demonstrated for both strategies, including all studies (RR: 1.09; 95% CI: 0.97-1.22; I 2: 82%) and when only RCTs were considered (RR: 1.15; 95% CI: 0.97-1.36).

Conclusion

The benefit of susceptibility-guided treatment over empirical treatment of H. pylori infection could not be demonstrated, either in first-line (if the most updated quadruple regimens are prescribed) or in rescue therapies.

Lansoprazole based quadruple therapy for treatment of patients with Helicobacter pylori associated gastric ulcer: Efficacy and impact on serum levels of interferon-γ, interleukin-2, and interleukin-12

AIM

To evaluate the clinical effects of lansoprazole based quadruple therapy in patients with Helicobacter pylori (H. pylori) associated gastric ulcer and the impact on serum levels of interferon-γ (IFN-γ), interleukin (IL)-2, and IL-12.

METHODS

One hundred and twenty cases treated from June 2016 to June 2017 at Hangzhou Hospital were randomly divided into a control group (n = 60) and an observation group (n = 60). The control group was given omeprazole based quadruple therapy, while the observation group was given lansoprazole based quadruple therapy. After treatment for 1 month, the total effective rate, H. pylori eradication rate, time to relief of symptoms, serum levels of IFN-γ, IL-2, and IL-12, levels of superoxide dismutase (SOD), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF), and adverse reactions in the two groups were observed. After follow-up for 6 mo, the rates of relapse in patients with H. pylori eradication and those with response to therapy were observed.

RESULTS

The total effective rate and H. pylori eradication rate were significantly better in the observation group than in the control group (100% vs 88.3%, 85.0% vs 96.7% P < 0.05 for both). The time to relief of abdominal pain, bloating, belching, and bleeding was significantly shorter in the observation group than in the control group (P < 0.05). After treatment, serum levels of IFN-γ, IL-2, and IL-12 in both groups were significantly lower than those before treatment (P < 0.05), and the observation group had significantly lower levels than the control group (P < 0.05); the levels of SOD, VEGF, and EGF were significantly improved in both groups compared with the values before treatment (P < 0.05), and the observation group had significantly better levels than the control group (P < 0.05). After follow-up for 6 mo, the relapse rates in patients with H. pylori eradication of the two groups were 17.65% and 3.44%, and the relapse rates in those with response to therapy were 15.09% and 3.33%; the observation group was significantly better than the control group (P < 0.05). There was no significant difference in adverse reactions between the two groups (P > 0.05).

CONCLUSION

Lansoprazole based quadruple therapy for treatment of patients with H. pylori associated gastric ulcer is significantly effective and can reduce the levels of inflammatory factors, promote gastric mucosal repair, and reduce relapse.