Gastroenterology Unit, 'Riuniti' Hospital, Foggia, Italy.
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Acta Gastroenterol Belg. 2022 Apr-Jun;85(2):295-299. doi: 10.51821/85.2.9680.
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 pooled- data analysis of data published in the last 15 years.
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.
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 (38.7%) incidence of side-effects.
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.
治愈 H. pylori 感染仍然具有挑战性，使用最有效的一线治疗方法是治疗的基石。为了监测意大利一线治疗的疗效，我们设计了一项系统评价，并对过去 15 年发表的数据进行了汇总分析。
搜索重点是标准方案和成年患者。排除了修改后的治疗方案、儿科患者、少于 5 例的病例系列以及非英语语言的研究。
共评估了 40 项研究，涉及 74 个治疗组和 13539 名患者。在 14 天三联疗法中，质子泵抑制剂（PPI）、克拉霉素和阿莫西林联合治疗的成功率最高（77.9%），而 14 天 PPI、克拉霉素和替硝唑方案的成功率最低（62.7%）。在过去十年中，三联疗法的总体疗效从 75.7%显著下降至 72.1%。序贯疗法（3431 例患者中 88.3%）、同时疗法（376 例患者中 88.8%）和基于铋的四联疗法（999 例患者中三一体胶囊包含枸橼酸铋钾（140mg）、甲硝唑（125mg）和四环素（125mg），根除率同样较高（90.4%），但同时疗法的数据仍有限。基于铋的四联疗法与较高（38.7%）的副作用发生率相关。
数据表明，由于成功率极低，意大利应放弃所有三联疗法，无论药物组合和治疗持续时间如何。监测其他国家标准一线治疗的疗效对患者和临床医生都具有临床意义。
