Jafri Nadim S, Hornung Carlton A, Howden Colin W
University of Louisville, Louisville, Kentucky 40202, USA.
Ann Intern Med. 2008 Jun 17;148(12):923-31. doi: 10.7326/0003-4819-148-12-200806170-00226. Epub 2008 May 19.
Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious.
To compare sequential therapy with standard triple therapy for H. pylori infection.
MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used.
Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection.
3 reviewers independently assessed trial eligibility and quality and extracted data on eradication.
The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n = 1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to 77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles.
Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias.
Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.
基于标准质子泵抑制剂的幽门螺杆菌感染治疗方案在多达四分之一的患者中失败。序贯疗法可能更有效。
比较序贯疗法与标准三联疗法治疗幽门螺杆菌感染的效果。
MEDLINE、EMBASE（1981年至2007年10月）、Cochrane对照试验中央注册库和谷歌学术。使用PubMed和Ovid作为搜索引擎。
比较初治幽门螺杆菌感染患者序贯疗法和标准三联疗法的随机对照试验（RCT）。
3名评审员独立评估试验的合格性和质量，并提取根除数据。
10项涉及2747例患者的RCT中，序贯疗法（n = 1363）的幽门螺杆菌根除粗率为93.4%（95%CI，91.3%至95.5%），标准三联疗法（n = 1384）为76.9%（CI，71.0%至82.8%）（相对风险降低71%[CI，64%至77%]；绝对风险降低16个百分点[CI，14至19个百分点]）。序贯疗法的依从性中位数为97.4%（范围，90.0%至98.9%），标准疗法为96.8%（范围，93.0%至100%）。在按试验质量、吸烟状况、诊断（溃疡病或非溃疡性消化不良）、对克拉霉素、咪唑或两者的耐药性、三联疗法持续时间和诊断方法分层的预先指定的敏感性（亚组）分析中，序贯疗法似乎更优。两种治疗的副作用谱相似。
只有1项研究是双盲的。大多数患者来自意大利。有明显的发表偏倚证据。
序贯疗法在根除幽门螺杆菌感染方面似乎优于标准三联疗法。如果其他国家的RCT证实这些发现，10天序贯疗法可能成为初治患者幽门螺杆菌感染的标准治疗方法。
