Eradication rates for Helicobacter pylori infection a systematic evidence - based review
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Hellenic Journal of Surgery (2015) 87:5, 377-386
Eradication Rates for Helicobacter Pylori Infection A Systematic Evidence - Based Review G. Sgourakis, A. Pindireki, A. Kouloura, G. Sourtse, V. Ganis, S. Peristeraki, K. Karkoulias, S. Georgopoulos, Ch. Karaliotas, S. Lanitis
Abstract 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. Key words: H. pylori eradication; practice-based evidence; systematic review; meta-analysis; ulcer bleeding; ulcer per-
foration
Introduction Helicobacter pylori (H. pylori) was detected and consequently cultured in 1982 by Marshall and Warren [1]. This particular bacterium is related to chronic gastritis [2], the
vast majority of peptic ulcers [3], adenocarcinoma of the stomach [4] a
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