STOMACH

The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis

Angelo Zullo¹, Vincenzo De Francesco², Cesare Hassan¹, Sergio Morini¹, Dino Vaira³

¹ Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
² Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
³ Gastroenterology Unit, Riuniti Hospital, Foggia, Italy

Correspondence to:
Dr D Vaira
S.Orsola-Maliphigi Hospital, Nuove Patologie, via Massarenti 9, Bologna 40138, Italy; vairadin{at}med.unibo.it

Background:: Standard triple therapies are the most used treatment in clinical practice. However, a critical fall in the H pylori eradication rate following these therapies has been observed in the last few years. The sequential regimen is a novel, promising therapeutic approach.

Objectives:: To evaluate the available data on the sequential therapy regimen.

Methods:: A pooled-data analysis of all studies on the sequential regimen was performed. The eradication rate was calculated according to gastroduodenal pathology, proton pump inhibitor used, antibiotic resistance, as well as setting (paediatric or geriatric patients). Compliance, side effects, and cost implications were also evaluated.

Results:: Overall, more than 1800 patients have been treated with the sequential regimen. Such a therapy was superior to 7–10 days triple therapies in paediatric, adult and elderly patients, achieving an eradication rate constantly higher than 90% at ITT analysis. Although primary clarithromycin resistance reduced the efficacy of such a therapy, a success rate significantly higher than that observed with the standard 7–10 days triple therapies was found.

Conclusion:: The 10-day sequential treatment regimen achieves higher eradication rates than standard triple therapies.

Abbreviations: CagA, cytotoxin-associated gene A; ITT, intention to treat; PP, per protocol; PPI, proton pump inhibitor

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller and Emad M El-Omar
Gut 2007 56: 1333. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Vaira, D., Zullo, A., Hassan, C., Fiorini, G., Vakil, N. (2009). Sequential therapy for Helicobacter pylori eradication: the time is now!. Therapeutic Advances in Gastroenterology 2: 317-322  
• Vakil, N., Vaira, D. (2008). Sequential Therapy for Helicobacter pylori: Time to Consider Making the Switch?. JAMA 300: 1346-1347 [Full Text]