Cho Jun-Hyung, Jin So-Young
Digestive Disease Center, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea.
Department of Pathology, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea.
Microorganisms. 2025 Feb 26;13(3):519. doi: 10.3390/microorganisms13030519.
This study aimed to evaluate the efficacy of adding bismuth to conventional triple therapy (modified bismuth quadruple therapy [mBQT]) for treatment-naïve patients in an era of increasing eradication failure. We performed a comprehensive literature search up to December 2024 using PubMed, Embase, and the Cochrane Library to investigate mBQT's benefits. The comparative treatments were as follows: (1) triple therapy without bismuth (TT), (2) non-BQTs (sequential and concomitant), and (3) classic BQT (cBQT) containing metronidazole and tetracycline. Randomized controlled trials (RCTs) were analyzed to compare eradication rates, adverse drug events, and patient compliance between the mBQT and comparison groups. In total, 9162 and 8449 patients from 43 trials in 35 RCTs were included in the intention-to-treat and per-protocol analyses, respectively. The mBQT group had a superior pooled eradication rate compared to the TT group (84.8% vs. 74.1%, < 0.00001, and odds ratio [OR] = 2.02 [1.61-2.55]). The mBQT showed a similar eradication rate to the non-BQT and cBQT groups (80.8% vs. 80.2%, = 0.55, and OR = 1.09 [0.83-1.43] in the non-BQT group; 81.5% vs. 83.0%, = 0.36, and OR = 0.84 [0.59-1.21] in the cBQT group). Regarding adverse drug events, there was no significant difference between the mBQT and comparison groups (25.4% vs. 27.5%, = 0.53, and OR = 0.95 [0.80-1.12]). The subgroup analysis showed that patient adherence to mBQT was significantly higher than to cBQT (96.4% vs. 93.3%, = 0.004, and OR = 1.83 [1.21-2.77]). Our meta-analysis showed that mBQT was an effective and tolerable first-line therapy for eradication.
本研究旨在评估在根除失败率不断上升的时代，对于初治患者，在传统三联疗法中添加铋剂（改良铋剂四联疗法[mBQT]）的疗效。我们利用PubMed、Embase和Cochrane图书馆进行了截至2024年12月的全面文献检索，以研究mBQT的益处。对照治疗如下：（1）不含铋剂的三联疗法（TT），（2）非铋剂四联疗法（序贯和联合），以及（3）含甲硝唑和四环素的经典铋剂四联疗法（cBQT）。分析随机对照试验（RCT）以比较mBQT组与对照组之间的根除率、药物不良事件和患者依从性。意向性分析和符合方案分析分别纳入了35项RCT中43项试验的9162例和8449例患者。与TT组相比，mBQT组的合并根除率更高（84.8%对74.1%，<0.00001，比值比[OR]=2.02[1.61 - 2.55]）。mBQT与非铋剂四联疗法组和cBQT组的根除率相似（非铋剂四联疗法组中80.8%对80.2%，=0.55，OR = 1.09[0.83 - 1.43]；cBQT组中81.5%对83.0%，=0.36，OR = 0.84[0.59 - 1.21]）。关于药物不良事件，mBQT组与对照组之间无显著差异（25.4%对27.5%，=0.53，OR = 0.95[0.80 - 1.12]）。亚组分析显示，患者对mBQT的依从性显著高于对cBQT的依从性（96.4%对93.3%，=0.004，OR = 1.83[1.21 - 2.77]）。我们的荟萃分析表明，mBQT是一种有效且耐受性良好的根除幽门螺杆菌一线疗法。
