Eradication rates for Helicobacter pylori infection a systematic evidence - based review

Aim The aim of this study is to summarize all available published studies regarding pharmacologic management of newly onset and recurrent peptic ulcers, provide a critical insight into indistinguishable features of H. pylori, and construct a useful clinical tool for decision making. Methods A thorough search was performed of electronic databases including MEDLINE, Embase, Pubmed, Scopus and Cochrane Library from 1990 up to 2014. A systematic review and meta-analysis was to be carried out, pooling the effects of outcomes of patients and lesions enrolled in the studies. Results The primary end-points of this thesis will be the construction of a pharmacological management algorithm of H. Pylori eradication in various disease states. In uncomplicated peptic ulcer, first line eradication therapy of H. pylori should include one of the following: triple [(PPI, clarithromycin, amoxicillin)-(PPI, clarithromycin, metronidazole)]/ quadruple (PPI, clarithromycin, amoxicillin, nitroimidazole)/Bismuth-containing (ranitidine, Bismuth subsalicylate, metronidazole, tetracycline) for 10-14 days or sequential for five days (PPI+amoxicillin) plus five days (PPI, clarithromycin, tinidazole). If the first line H. pylori eradication regimen is unsuccessful, second line H. pylori eradication regimens should comprise one of the following: Bismuth based/triple (levofloxacin substitutes clarithromycin). In cases of clarithromycin resistance, H. pylori eradication regimens should include one of the following: Bismuth-based /quadruple/sequential (levofloxacin substitutes clarithromycin). In cases of metronidazole resistance, H. pylori eradication regimens should incorporate one of the following: triple/ sequential (levofloxacin substitutes clarithromycin). In cases of clarithromycin and metronidazole resistance H. pylori eradication regimens should include the following: sequential (levofloxacin substitutes clarithromycin). Conclusion Though there is sufficient evidence to safeguard Grade A recommendations for H. pylori eradication regimens in cases of first- and second-line treatments, resistance and peptic ulcer complications, high-quality randomized controlled trials that will include distinct ethnic groups, homogeneous endoscopic diagnosis and treatment, double-blind designs, and evaluation of outcomes operating specific criteria over set follow-up periods are lacking.