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A 10- or 14-day Bismuth-containing Quadruple Therapy as a First-line Helicobacter pylori Eradication Therapy: A Systematic Review and Meta-analysis

 Sung Eun Kim  ;  Hye-Kyung Jung  ;  Seung Joo Kang  ;  Yong Chan Lee  ;  Hyo-Joon Yang  ;  Seon-Young Park  ;  Cheol Min Shin  ;  Hyun Chul Lim  ;  Jie-Hyun Kim  ;  Su Youn Nam  ;  Woon Geon Shin  ;  Jae Myung Park  ;  Il Ju Choi  ;  Jae Gyu Kim  ;  Miyoung Choi 
 Korean Journal of Helicobacter and Upper Gastrointestinal Research, Vol.21(1) : 48-58, 2021-03 
Journal Title
Korean Journal of Helicobacter and Upper Gastrointestinal Research
Issue Date
Adverse effects ; Bismuth tripotassium dicitrate ; Disease eradication ; Helicobacter pylori ; Meta-analysis
The eradication rate of the first-line standard triple therapy (STT) for Helicobacter pylori (H. pylori) infection has decreased since 2000; therefore, other first-line therapies are required. This study was aimed at investigating the efficacy of bismuth-containing quadruple therapy (PBMT) for first-line H. pylori eradication compared to STT, sequential therapy (SQT), and concomitant therapy (CT).
Materials and Methods
The Ovid-MEDLINE, Koreamed, EMBASE, KMBASE, and Cochrane Library databases were searched from January 2008 to July 2018. All identified randomized controlled trials (RCTs) comparing PBMT and non-PBMT for first-line H. pylori eradication therapy were included in the final analysis.
A total of 3,653 patients from seven RCTs were enrolled. The pooled eradication rates of PBMT by intention-to-treat (ITT) and per-protocol (PP) analyses were 82.1% (95% CI, 68.2~90.8%) and 88.8% (95% CI, 77.1~94.9%), respectively. However, no statistically significant difference was observed in eradication rates of the 10- or 14-day PBMT as compared to 14-day STT, 10-day SQT, and 10-day CT in ITT and PP analyses. PBMT was significantly higher in adverse events than in the other eradication regimens (RR, 1.64; 95% CI, 1.11~2.44). Considerable heterogeneity in adverse events was observed among studies (χ2=88.7; P<0.001, I2=93%).
PBMT can be the first-line treatment for H. pylori eradication in Korea when other first-line options, including STT, SQT, or CT, are unavailable due to their high adverse event rates.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lim, Hyun Chul(임현철)
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