After 30 years of experience in Helicobacter pylori treatment, however, the
ideal regimen to treat this infection has still to be found. Systematic reviews and metaanalyses
are essential to summarize evidence relating to efficacy and safety of health
care interventions accurately and reliably. The aim of this chapter is to review published
meta-analyses focused on H. pylori eradication treatments. Initially, dual therapies
containing one antibiotic combined with bismuth compounds or proton pump inhibitors
(PPIs) obtained sub-optimal cure rates. The most recommended therapies have been
triple therapies containing a PPI and two antibiotics. PPI-based regimens are more
effective than H2-antagonists-based ones. Bismuth-containing quadruple therapy is
roughly equivalent to triple therapy in terms of effectiveness, compliance and safety
profile. The influence of the type of PPI, the dosage and the length of treatment have
been discussed. Clarithromycin and metronidazole antibiotic resistance are the most
relevant factors causing eradication failure. As a progressive decrease in the eradication
rate after standard triple therapy has been reported, more recently, sequential and nonbismuth
quadruple (concomitant) therapies have been recommended in settings where
the efficacy of triple therapy is unacceptably low. The role of prebiotics and probiotics
as adjunctive treatment for H. pylori infection has also been reviewed. Several rescue
options have been proposed. Bismuth-based quadruple therapy is effective, but its
complexity and the associated adverse effects affect compliance. PPI plus amoxicillin
combined with levofloxacin or moxifloxacin is at least as effective, and better tolerated.
Keywords: Helicobacter pylori, meta-analysis, proton pump inhibitor, bismuth,
ranitidine bismuth citrate, clarithromycin, amoxicillin, levofloxacin, treatment,
therapy, omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole,
sequential therapy, concomitant therapy, resistance.
