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The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis
  1. Angelo Zullo1,
  2. Vincenzo De Francesco2,
  3. Cesare Hassan1,
  4. Sergio Morini1,
  5. Dino Vaira3
  1. 1Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
  2. 2Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
  3. 3Gastroenterology Unit, Riuniti Hospital, Foggia, Italy
  1. Correspondence to:
    Dr D Vaira
    S.Orsola-Maliphigi Hospital, Nuove Patologie, via Massarenti 9, Bologna 40138, Italy; vairadin{at}


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.

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

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  • Published Online First 13 June 2007

  • Competing interests: D. Vaira holds stock options for Meridian Bioscience, Cincinnati, Ohio, USA.

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