Comparative effectiveness and tolerance of treatments for Helicobacter pylori : systematic review and network meta-analysis
Open accessAbstract
OBJECTIVE: To determine the most efficacious treatment for eradication of Helicobacter pylori with the lowest likelihood of some common adverse events among pre-recommended and newer treatment regimens. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Cochrane Library, PubMed, and Embase without language or date restrictions. STUDY SELECTION: Full text reports of randomised controlled trials that compared different eradication treatments for H pylori among adults. RESULTS: Of the 15,565 studies identified, 143 were eligible and included. Data on 14 kinds of treatments were available. Of 91 possible comparisons for the efficacy outcome, 34 were compared directly and the following treatments performed better: seven days of concomitant treatment (proton pump inhibitor and three kinds of antibiotics administered together), 10 or 14 days of concomitant treatment, 10 or 14 days of probiotic supplemented triple treatment (standard triple treatment which is probiotic supplemented), 10 or 14 days of levofloxacin based triple treatment (proton pump inhibitor, levofloxacin, and antibiotic administered together), 14 days of hybrid treatment (proton pump inhibitor and amoxicillin used for seven days, followed by a proton pump inhibitor, amoxicillin, clarithromycin, and 5-nitroimidazole for another seven days), and 10 or 14 days of sequential treatment (five or seven days of a proton pump inhibitor plus amoxicillin, followed by five or seven additional days of a proton pump inhibitor plus clarithromycin and 5-nitroimidazole or amoxicillin). In terms of tolerance, all treatments were considered tolerable, but seven days of probiotic supplemented triple treatment and seven days of levofloxacin based triple treatment ranked best in terms of the proportion of adverse events reported. CONCLUSION: Comparison of different eradication treatments for H pylori showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, 10 or 14 days of levofloxacin based triple treatment, 14 days of hybrid treatment, and 10 or 14 days of sequential treatment might be better alternatives for the eradication of H pylori.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A meta-analysis of clinical trials showed that probiotics could be as effective as pharmacological approaches for H. pylori treatment and were the best treatment in terms of patient tolerance.
“Li and coworkers (117) published a meta-analysis that compiled the clinical trial studies involving H. pylori treatment, and they showed that the use of probiotics could be as effective as pharmacological approaches. In addition, probiotics were revealed in the same analysis as the best treatment in terms of tolerance for the patient.”
From Bifidobacteria and Their Health-Promoting Effects (2017) · cites this paper as [117]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Assessing the quality of reports of randomized clinical trials: Is blinding necessary?
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996) · Controlled Clinical Trials · doi:10.1016/0197-2456(95)00134-4 · Cited by 17,582 · see citing works
Zhang, Q., Wang, C., Zheng, M., Li, Y., Li, J., Zhang, L., Shang, X., & Yan, C. (2014) · Cerebrovascular Diseases · doi:10.1159/000369778 · Cited by 11,609 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions
Higgins, J. P. T., Green, S., & Ben Van Den, A. (2020) · International Coaching Psychology Review · doi:10.53841/bpsicpr.2020.15.2.123 · Cited by 5,670 · see citing works
Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration
Marshall, B., & Warren, J. R. (1984) · The Lancet · doi:10.1016/s0140-6736(84)91816-6 · Cited by 5,509 · see citing works
Dong, Y., Hao, L., Shi, Z., Wang, G., Zhang, Z., & Han, C. (2013) · Urologia Internationalis · doi:10.1159/000351405 · Cited by 4,556 · see citing works
Graphical tools for network meta-analysis in STATA
Chaimani, A., Higgins, J. P. T., Mavridis, D., Spyridonos, P., & Salanti, G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0076654 · Cited by 2,473 · see citing works
Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report
Malfertheiner, P., Mégraud, F., O'Morain, C. A., Atherton, J. C., Axon, A. T. R., Bazzoli, F., Gensini, G. F., Gisbert, J. P., Graham, D. Y., Rokkas, T., et al. (2012) · Gut · doi:10.1136/gutjnl-2012-302084 · Cited by 2,346 · see citing works
Malfertheiner, P., Mégraud, F., O'Morain, C. A., Bazzoli, F., El-Omar, E. M., Graham, D., Hunt, R. H., Rokkas, T., Vakil, N. B., Kuipers, E. J., et al. (2006) · Gut · doi:10.1136/gut.2006.101634 · Cited by 2,242 · see citing works
Malfertheiner, P., Mégraud, F., O'Morain, C. A., Hungin, A. P. S., Jones, R. H., Axon, A. T. R., Graham, D. Y., Tytgat, G. N. J., & The European Helicobacter Pylori Study Group (EHPSG) (2002) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2002.01169.x · Cited by 1,238 · see citing works
Helicobacter pylori treatment in the era of increasing antibiotic resistance
Graham, D. Y., & Fischbach, L. A. (2010) · Gut · doi:10.1136/gut.2009.192757 · Cited by 1,031 · see citing works
An African origin for the intimate association between humans and Helicobacter pylori
Linz, B., Balloux, F., Moodley, Y., Manica, A., Liu, H., Roumagnac, P., Falush, D., Stamer, C., Prugnolle, F., der Merwe, V., et al. (2007) · Nature · doi:10.1038/nature05562 · Cited by 977 · see citing works
Epidemiology of Helicobacter pylori infection
Leja, M., Axon, A. T. R., & Brenner, H. (2016) · Helicobacter · doi:10.1111/hel.12332 · Cited by 884 · see citing works
McColl, K. E. L. (2010) · New England Journal of Medicine · doi:10.1056/nejmcp1001110 · Cited by 776 · see citing works
Dias, S., Welton, N. J., Sutton, A. J., & Ades, A. E. (2011) · Bristol Research (University of Bristol) · Cited by 558 · see citing works
Epidemiology ofHelicobacter pyloriInfection
Eusebi, L. H., Zagari, R. M., & Bazzoli, F. (2014) · Helicobacter · doi:10.1111/hel.12165 · Cited by 517 · see citing works
Evidence Synthesis for Decision Making 3
Dias, S., Sutton, A. J., Welton, N. J., & Ades, A. E. (2013) · Medical Decision Making · doi:10.1177/0272989x13485157 · Cited by 468 · see citing works
Epidemiology of Helicobacter pylori Infection
Lehours, P., & Yilmaz, O. (2007) · Helicobacter · doi:10.1111/j.1523-5378.2007.00541.x · Cited by 451 · see citing works
Probiotic immunomodulation in health and disease
Erickson, K. L., & Hubbard, N. E. (2000) · The Journal of Nutrition · doi:10.1093/jn/130.2.403s · Cited by 372 · see citing works
Beyond the stomach: An updated view ofHelicobacter pyloripathogenesis, diagnosis, and treatment
Testerman, T. L. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i36.12781 · Cited by 337 · see citing works
Gatta, L., Vakil, N. B., Vaira, D., & Scarpignato, C. (2013) · BMJ · doi:10.1136/bmj.f4587 · Cited by 271 · see citing works
Liou, J., Chen, C., Chen, M., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61579-7 · Cited by 271 · see citing works
Sequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori Eradication
Vaira, D., Zullo, A., Vakil, N. B., et al. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-146-8-200704170-00006 · Cited by 266 · see citing works
Sequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori Eradication
(2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-146-8-200704170-00002 · Cited by 262 · see citing works
Yuan, J., Zhang, R., Yang, Z., Lee, J., Liu, Y., Tian, J., Qin, X., Ren, Z., Ding, H., Chen, Q., et al. (2013) · European Urology · doi:10.1016/j.eururo.2013.01.012 · Cited by 260 · see citing works
Self-citationGreenberg, E. R., Anderson, G. L., Morgan, D. R., Torres, J., Chey, W. D., Bravo, L. E., Domínguez, R. L., Catterina Ferreccio, R., Herrero, R., Lazcano-Ponce, E. C., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60825-8 · Cited by 256 · see citing works
Wu, D., Hsu, P., Wu, J., et al. (2009) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2009.09.030 · Cited by 245 · see citing works
Optimum duration of regimens for Helicobacter pylori eradication
Yuan, Y., Ford, A. C., Khan, K. J., Gisbert, J. P., Forman, D., Leontiadis, G. I., Tse, F., Calvet, X., Fallone, C. A., Fischbach, L. A., et al. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008337.pub2 · Cited by 194 · see citing works
Bacillus clausii Probiotic Strains
Urdaci, M. C., Bressollier, P., & Pinchuk, I. (2004) · Journal of Clinical Gastroenterology · doi:10.1097/01.mcg.0000128925.06662.69 · Cited by 182 · see citing works
Review article: non-bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori
Gisbert, J. P., & Calvet, X. (2011) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2011.04770.x · Cited by 180 · see citing works
Wang, Z., Gao, Q., & Fang, J. (2012) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e318266f6cf · Cited by 172 · see citing works
Dang, Y., Reinhardt, J. D., Zhou, X., & Zhang, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0111030 · Cited by 168 · see citing works
Venerito, M., Krieger, T., Ecker, T., et al. (2013) · Digestion · doi:10.1159/000350719 · Cited by 167 · see citing works
Treatment of Latent Tuberculosis Infection
Stagg, H. R., Zenner, D., Harris, R., Muñoz, L., Lipman, M. C. I., & Abubakar, I. (2014) · Annals of Internal Medicine · doi:10.7326/m14-1019 · Cited by 160 · see citing works
Dias, S., Sutton, A. J., Welton, N. J., & Ades, A. E. (2011) · Bristol Research (University of Bristol) · Cited by 158 · see citing works
Alfertheiner, P. M., & Roup, S. T. G. (2002) · Cited by 132 · see citing works
Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori
Gisbert, J. P., & Calvet (2012) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s25419 · Cited by 130 · see citing works
Optimum duration of regimens for Helicobacter pylori eradication
Yuan, Y., Ford, A. C., Khan, K. J., Forman, D., Oderda, G., Calvet, X., Leontiadis, G. I., Fallone, C. A., Gisbert, J. P., Fischbach, L. A., et al. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008337 · Cited by 125 · see citing works
Zou, J., Dong, J., & Yu, X. (2009) · Helicobacter · doi:10.1111/j.1523-5378.2009.00716.x · Cited by 121 · see citing works
Meta-analysis of the efficacy of probiotics in Helicobacter pylori eradication therapy
Zhu, R., Chen, K., Zheng, Y., Zhang, H., Wang, J., Xia, Y., Dai, W., Wang, F., Shen, M., Cheng, P., et al. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i47.18013 · Cited by 100 · see citing works
Self-citationGong, E. J., Yun, S., Jung, H., et al. (2014) · Journal of Korean Medical Science · doi:10.3346/jkms.2014.29.5.704 · Cited by 96 · see citing works
Song, M., Park, D. I., Park, J. H., Kim, H. J., Cho, Y. K., Sohn, C. I., Jeon, W. K., & Kim, B. I. (2010) · Helicobacter · doi:10.1111/j.1523-5378.2010.00751.x · Cited by 93 · see citing works
EPIDEMIOLOGY OF HELICOBACTER PYLORI INFECTION
Kist, M. (1997) · Shock · doi:10.1097/00024382-199703001-00543 · Cited by 91 · see citing works
Adjuvant probiotics improve the eradication effect of triple therapy forHelicobacter pyloriinfection
Du, Y. (2012) · World Journal of Gastroenterology · doi:10.3748/wjg.v18.i43.6302 · Cited by 84 · see citing works
Loymans, R. J. B., Gemperli, A., Cohen, J., Rubinstein, S. M., Sterk, P. J., Reddel, H. K., Jüni, P., & ter Riet, G. (2014) · BMJ · doi:10.1136/bmj.g3009 · Cited by 74 · see citing works
den Hollander, W. J., Holster, I. L., den Hoed, C. M., van Deurzen, F., van Vuuren, A. J., Jaddoe, V. W. V., Albert Hofman, D., Perez, G. I. P., Blaser, M. J., Moll, H. A., et al. (2013) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.12315 · Cited by 69 · see citing works
Sequential regimens for Helicobacter pylori eradication
Moayyedi, P. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61455-x · Cited by 63 · see citing works
Current options for the treatment ofHelicobacter pylori
Georgopoulos, S. D., Papastergiou, V., & Karatapanis, S. (2013) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2013.763926 · Cited by 57 · see citing works
Standard triple therapy for Helicobacter pylori infection in China: A meta-analysis
Wang, B. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i40.14973 · Cited by 51 · see citing works
Hung, I. F., Chan, P., Leung, S. S. M., et al. (2009) · Helicobacter · doi:10.1111/j.1523-5378.2009.00722.x · Cited by 41 · see citing works
Wang, B., Wang, Y., Lv, Z., et al. (2014) · Helicobacter · doi:10.1111/hel.12180 · Cited by 39 · see citing works
Helicobacter pylorieradication in West Asia: A review
Fakheri, H. T. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i30.10355 · Cited by 29 · see citing works
Valooran, G. J., Kate, V., Jagdish, S., et al. (2011) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365521.2011.584894 · Cited by 27 · see citing works
Uygun, A., Kadayıfçı, A., Polat, Z., et al. (2012) · The Turkish Journal of Gastroenterology · doi:10.4318/tjg.2012.0392 · Cited by 25 · see citing works
Ching, S. S., Sabanathan, S., & Jenkinson, L. R. (2008) · World Journal of Gastroenterology · doi:10.3748/wjg.14.3855 · Cited by 23 · see citing works
Kim, J. S., Ji, J., Choi, H., et al. (2013) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2013.10.001 · Cited by 21 · see citing works
Ye, C., Liao, G., He, S., et al. (2014) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.3581 · Cited by 21 · see citing works
Aydın, A., Onder, G., Akarca, U. S., et al. (2007) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2007.02.018 · Cited by 16 · see citing works
Yi-Qi, Du, Tun, T., et al. (2012) · Acta Scientiarum Naturalium Universitatis Sunyatseni · Cited by 15 · see citing works
Meta-analysis of the efficacy of probiotics in Helicobacter pylori eradication therapy
Rong, R., Zhu, Z., Kan, K., et al. (2014) · Acta Scientiarum Naturalium Universitatis Sunyatseni · Cited by 13 · see citing works
Shindel, A. W. (2014) · Yearbook of Urology · doi:10.1016/j.yuro.2013.08.014 · Cited by 12 · see citing works
Standard triple therapy for Helicobacter pylori infection in China: A meta-analysis
Ben, Wang, Zhi-Fa, et al. (2014) · Acta Scientiarum Naturalium Universitatis Sunyatseni · Cited by 11 · see citing works
Ungan, M., Kulaçoğlu, H., & Kayhan, B. (2001) · Current Therapeutic Research · doi:10.1016/s0011-393x(01)80057-6 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Bifidobacteria and Their Health-Promoting Effects
Hidalgo-Cantabrana, C., Delgado, S., Ruiz, L., Ruas-Madiedo, P., Sánchez, B., & Margolles, A. (2017) · Microbiology Spectrum · doi:10.1128/microbiolspec.bad-0010-2016 · Cited by 490 · see citing works
- Authors
- Li, B.-Z., Threapleton, D. E., Wang, J.-Y., Xu, J.-M., Yuan, J.-Q., Zhang, C., Li, P., Ye, Q.-L., Guo, B., Mao, C., & Ye, D.-Q.
- Affiliations
- Anhui Medical University (CN)
- Chinese University of Hong Kong (HK)
- First Affiliated Hospital of Anhui Medical University (CN)
- Second Affiliated Hospital of Anhui Medical University (CN)
- Corresponding author
- Ye, Dong-Qing
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2015-08-19
- Volume
- 351
- Pages
- h4052
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4541168
- OpenAlex
- W2142452897
- Cited by
- 176
- References
- 64
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 16 · 2023: 10 · 2022: 18 · 2021: 26 · 2020: 16 · 2019: 10 · 2018: 11 · 2017: 23 · 2016: 24 · 2015: 5
- FWCI
- 4.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- Helicobacter pylori, eradication therapy, comparative effectiveness, treatment tolerance, adverse events, probiotic supplementation, levofloxacin, triple therapy, concomitant therapy, hybrid therapy, sequential therapy, clarithromycin, amoxicillin, proton pump inhibitors, 5-nitroimidazoles
- MeSH terms
- Amoxicillin, Anti-Bacterial Agents, Drug Therapy, Combination, Humans, Metronidazole, Nitroimidazoles, Helicobacter pylori, Helicobacter Infections, Clarithromycin, Probiotics, Proton Pump Inhibitors, Levofloxacin
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
