Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China.
School of Basic Medicine, Medical College of Putian University, Putian, China.
Helicobacter. 2023 Aug;28(4):e12989. doi: 10.1111/hel.12989. Epub 2023 May 17.
The eradication rate of Helicobacter pylori (H. pylori) remains variable for the same eradication regime even in the identical region, especially in developing countries. Herein, we conducted a systematic review to assess the effect of reinforced medication adherence on H. pylori eradication rate in developing countries.
A systematic review was conducted in literature databases to identify relevant randomized controlled trials (RCTs) from inception to March 2023. The core indicator was the changes in eradication rate after enhanced adherence. A meta-analysis was performed to estimate the pooled relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (CI).
Nineteen RCTs that included a total of 3286 patients were assessed. The measures to enhance compliance were mainly through face-to-face communication, phone calls, text messages, and social software. Compared with the control group, patients received reinforced measures showed a better medication adherence (89.6% vs. 71.4%, RR = 1.26 95% CI: 1.16-1.37), higher H. pylori eradication rate (intention-to-treat analysis: 80.2% vs. 65.9%, RR = 1.25, 95% CI: 1.12-1.31; per-protocol analysis: 86.8% vs. 74.8%, RR = 1.16, 95% CI: 1.09-1.23), higher symptom relief rates (81.8% vs. 65.1%, RR = 1.23, 95% CI: 1.09-1.38), higher degree of satisfaction (90.4% vs. 65.1%, RR = 1.26, 95% CI: 1.19-1.35), higher disease knowledge rates (SMD = 1.82, 95% CI: 0.77-2.86, p = 0.0007), and lower incidence of total adverse events (27.3% vs. 34.7%, RR = 0.72, 95% CI: 0.52-0.99).
Based on available evidence, reinforced medication adherence as a nonnegligible measure improves H. pylori eradication rate in developing countries.
即使在同一地区，相同的根除方案对幽门螺杆菌（H. pylori）的根除率也存在差异，尤其是在发展中国家。在此，我们进行了一项系统评价，以评估强化药物依从性对发展中国家 H. pylori 根除率的影响。
我们在文献数据库中进行了系统评价，以确定从开始到 2023 年 3 月的相关随机对照试验（RCT）。核心指标是强化依从性后根除率的变化。采用荟萃分析估计合并相对风险（RR）或加权均数差（WMD）及其 95%置信区间（CI）。
共纳入 19 项 RCT，共计 3286 例患者。强化依从性的措施主要通过面对面沟通、电话、短信和社交软件进行。与对照组相比，接受强化措施的患者具有更好的药物依从性（89.6%比 71.4%，RR=1.26，95%CI：1.16-1.37），更高的 H. pylori 根除率（意向治疗分析：80.2%比 65.9%，RR=1.25，95%CI：1.12-1.31；方案分析：86.8%比 74.8%，RR=1.16，95%CI：1.09-1.23），更高的症状缓解率（81.8%比 65.1%，RR=1.23，95%CI：1.09-1.38），更高的满意度（90.4%比 65.1%，RR=1.26，95%CI：1.19-1.35），更高的疾病知识率（SMD=1.82，95%CI：0.77-2.86，p=0.0007），以及更低的总不良反应发生率（27.3%比 34.7%，RR=0.72，95%CI：0.52-0.99）。
根据现有证据，强化药物依从性作为一项不可忽视的措施，可提高发展中国家的 H. pylori 根除率。
