Eradication of Helicobacter pylori infection in Europe: a meta-analysis based on congress abstracts, 1997-2002

BACKGROUND: Meta-analyses evaluated several aspects of Helicobacter pylori eradication based on the randomised controlled trials. AIM: to perform a meta-analysis of the papers presented at the European Helicobacter Pylori Study Group and United European Gastroenterology Week meetings from 1997 to 2002. METHODS: Abstracts dealing with the eradication of Helicobacter pylori have been reviewed and the randomised, controlled studies from European countries were included. The studies were classified into groups based on eradication schedules, antibiotics used and country of provenience. The pooled eradication rates were calculated and the differences were assessed by multiple variance analysis. RESULTS: One-hundred and two studies were accepted comprising 25,644 cases and 398 treatment arms. The eradication rate of proton pump inhibitor-based first line triple therapies was 80.4% (confidence interval: 78.9-81.8); no difference was observed between the five proton pump inhibitors (p > 0.05). Ranitidine bismuth citrate based regimens were efficient in 79.9% (75.7-84.0) (p = 0.95 vs PPI). H2 blockers-based therapies achieved 68.6% (59.0-78.1) (p = 0.0007 vs proton pump inhibitor and p = 0.005 vs ranitidine bismuth citrate-based regimens). Proton pump inhibitor-based double combinations were efficient in 47.1 (31.9-62.4) (p = 0.001 vs triple regimens). Clarithromycin+amoxicillin/nitroimidazole combinations achieved rates of 79.6% and 84.1%, respectively, while amoxicillin-nitroimidazole regimens were less efficient (72.5%, 66.6-78.5) (p = 0.006). The pooled eradication rate of second-line triple regimens was 75.5% (69.9-86.4)(p = 0.08 vs primary treatment). Quadruple therapies were successful in 81.1% (76.6-85.6) of cases as first-line and 73.8% (61.2-86.4) as second-line regimens (p = 0.77 and p = 0.02 vs triple regimens). The pooled eradication rates varied from 58% to 92% in the European countries. CONCLUSIONS: The pooled eradication rate of the primary proton pump inhibitor/ranitidine bismuth citrate-based triple regimens are comparable with the results of meta-analyses. H2 blocker-based triple and proton pump inhibitor-based double regimens are of lower efficacy. Quadruple regimens were not better than triple therapies. The eradication rates per country varied, approaching 80% in most places.The results confirm in part post-hoc the validity of the Maastricht consensus recommendations.