Meta‐analysis: high‐dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication

Summary Background  The evidence on whether high‐dose proton pump inhibitors (PPIs) increase cure rates of Helicobacter pylori treatment has not been previously assessed. Aim  To evaluate the evidence on the usefulness of high‐dose PPI in standard triple therapy by performing a systematic review and...

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Published in:Alimentary pharmacology & therapeutics 2008-10, Vol.28 (7), p.868-877
Main Authors: VILLORIA, A., GARCIA, P., CALVET, X., GISBERT, J. P., VERGARA, M.
Format: Article
Language:English
Subjects:
2-Pyridinylmethylsulfinylbenzimidazoles - administration & dosage
2-Pyridinylmethylsulfinylbenzimidazoles - therapeutic use
Bacterial diseases
Bacterial diseases of the digestive system and abdomen
Biological and medical sciences
Digestive system
Drug Administration Schedule
Esomeprazole
Gastroenterology. Liver. Pancreas. Abdomen
Helicobacter Infections - drug therapy
Helicobacter pylori
Human bacterial diseases
Humans
Infectious diseases
Medical sciences
Omeprazole - administration & dosage
Omeprazole - therapeutic use
Pharmacology. Drug treatments
Proton Pump Inhibitors - administration & dosage
Proton Pump Inhibitors - therapeutic use
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Summary:Summary Background  The evidence on whether high‐dose proton pump inhibitors (PPIs) increase cure rates of Helicobacter pylori treatment has not been previously assessed. Aim  To evaluate the evidence on the usefulness of high‐dose PPI in standard triple therapy by performing a systematic review and a meta‐analysis. Methods  A systematic search was performed in multiple databases and in the s submitted to the Digestive Diseases Week, the European Helicobacter Study Group congress and the United European Gastroenterology Week. Randomized trials comparing a standard dose of a PPI with high‐dose PPI both twice a day in triple therapy combining a PPI plus clarithromycin and either amoxicillin or metronidazole were selected. Relative risk (RR) and 95% confidence intervals (95% CIs) for all comparisons were calculated using Review Manager. Results  Six studies fulfilled the inclusion criteria. All used triple therapy for 7 days. A mean intention‐to‐treat cure rate of 82% was achieved with high‐dose PPI and one of 74% with standard dose (RR: 1.09; 95% CI: 1.01–1.17). Subgroup analysis showed that the maximum increase was observed when the PPI compared were omeprazole 20 mg or pantoprazole 40 mg vs. esomeprazole 40 mg. Conclusion  High‐dose PPI seems more effective than standard‐dose for curing H. pylori infection in 7‐day triple therapy.
ISSN:0269-2813
1365-2036
DOI:10.1111/j.1365-2036.2008.03807.x