Meta-Analysis of First-Line Triple Therapy for Helicobacter pylori Eradication in Korea: Is It Time to Change?

Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and...

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Published inJournal of Korean medical science Vol. 29; no. 5; pp. 704 - 713
Main Authors Gong, Eun Jeong, Yun, Sung-Cheol, Jung, Hwoon-Yong, Lim, Hyun, Choi, Kwi-Sook, Ahn, Ji Yong, Lee, Jeong Hoon, Kim, Do Hoon, Choi, Kee Don, Song, Ho June, Lee, Gin Hyug, Kim, Jin-Ho
Format Journal Article
LanguageEnglish
Published Korea (South) The Korean Academy of Medical Sciences 01.05.2014
대한의학회
Subjects
Alkylating Agents - therapeutic use
Amoxicillin - therapeutic use
Anti-Bacterial Agents - therapeutic use
Anti-Ulcer Agents - therapeutic use
Clarithromycin - therapeutic use
Communicable Disease Control
Cytochrome P-450 CYP3A Inhibitors - therapeutic use
Disease Eradication
Drug Resistance, Bacterial
Drug Therapy, Combination
Gastritis - microbiology
Gastritis - pathology
Helicobacter Infections - drug therapy
Helicobacter pylori
Humans
Metronidazole - therapeutic use
Original
Proton Pump Inhibitors - therapeutic use
Republic of Korea
Tinidazole - therapeutic use
의학일반
Republic of Korea
Helicobacter pylori
Triple Therapy
Eradication
Online AccessGet full text
ISSN1011-8934
1598-6357
1598-6357
DOI10.3346/jkms.2014.29.5.704

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Abstract Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.
AbstractList Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, andclarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. Weanalyzed the eradication rate and adverse events of triple therapy to evaluate currentpractices in Korea. A comprehensive literature search was performed up to August 2013 of104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6%(95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0%(95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreasedsignificantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocolanalyses). Adverse events were reported in 41 studies with 8,018 subjects with an overallincidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that theeffectiveness of standard triple therapy for H. pylori eradication has decreased to anunacceptable level. A novel therapeutic strategy is warranted to improve the effectivenessof first-line treatment for H. pylori infection in Korea. KCI Citation Count: 48
Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.
Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 ( P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.
Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.
Author Lim, Hyun
Yun, Sung-Cheol
Ahn, Ji Yong
Kim, Do Hoon
Lee, Gin Hyug
Kim, Jin-Ho
Gong, Eun Jeong
Choi, Kwi-Sook
Choi, Kee Don
Jung, Hwoon-Yong
Lee, Jeong Hoon
Song, Ho June
AuthorAffiliation 3 Department of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, Korea
2 Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
1 Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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– sequence: 6
  givenname: Ji Yong
  orcidid: 0000-0002-0030-3744
  surname: Ahn
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  organization: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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  givenname: Jeong Hoon
  orcidid: 0000-0002-0778-7585
  surname: Lee
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  organization: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
– sequence: 8
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  orcidid: 0000-0002-4250-4683
  surname: Kim
  fullname: Kim, Do Hoon
  organization: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
– sequence: 9
  givenname: Kee Don
  orcidid: 0000-0002-2517-4109
  surname: Choi
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  organization: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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  givenname: Ho June
  orcidid: 0000-0001-9255-1464
  surname: Song
  fullname: Song, Ho June
  organization: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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  orcidid: 0000-0003-3776-3928
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  orcidid: 0000-0002-6533-3127
  surname: Kim
  fullname: Kim, Jin-Ho
  organization: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Keywords Helicobacter pylori
Triple Therapy
Eradication
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Eun Jeong Gong and Sung-Cheol Yun contributed equally to this work.
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  year: 2014
  text: 2014-05-01
  day: 01
PublicationDecade 2010
PublicationPlace Korea (South)
PublicationPlace_xml – name: Korea (South)
PublicationTitle Journal of Korean medical science
PublicationTitleAlternate J Korean Med Sci
PublicationYear 2014
Publisher The Korean Academy of Medical Sciences
대한의학회
Publisher_xml – name: The Korean Academy of Medical Sciences
– name: 대한의학회
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Snippet Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter...
Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter...
Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, andclarithromycin, is the recommended first-line treatment for Helicobacter...
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SubjectTerms Alkylating Agents - therapeutic use
Amoxicillin - therapeutic use
Anti-Bacterial Agents - therapeutic use
Anti-Ulcer Agents - therapeutic use
Clarithromycin - therapeutic use
Communicable Disease Control
Cytochrome P-450 CYP3A Inhibitors - therapeutic use
Disease Eradication
Drug Resistance, Bacterial
Drug Therapy, Combination
Gastritis - microbiology
Gastritis - pathology
Helicobacter Infections - drug therapy
Helicobacter pylori
Humans
Metronidazole - therapeutic use
Original
Proton Pump Inhibitors - therapeutic use
Republic of Korea
Tinidazole - therapeutic use
의학일반
Title Meta-Analysis of First-Line Triple Therapy for Helicobacter pylori Eradication in Korea: Is It Time to Change?
URI https://www.ncbi.nlm.nih.gov/pubmed/24851029
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Volume 29
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