Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

Afify, Shimaa; Abdel-Gawad, Muhammad; Bahbah, Eshak I.; Zaghloul, Mariam; Abu-Elfatth, Ahmed; Alzamzamy, Ahmed; Nagui, Gina Gamal; Elwazzan, Doaa; Abdeen, Nermeen; Tharwat, Mina; Elbahr, Osama; Charif, Iliass; Aboufarrag, Galal; Elbadry, Mohamed; Omran, Dalia; Abd-Elsalam, Sherif; Ali-Eldin, Zainab; Makhlouf, Nahed A.; Alboraie, Mohamed

doi:10.21608/gg.2023.203591.1010

Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

Document Type : Meta-analyses and research proposals which bring new innovations to the field of gastroenterology.

Authors

¹ Gastroenterology department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.

² Hepatology, Gastroenterology, and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt.

³ Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

⁴ Gastroenterology and Infectious Diseases department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

⁵ Tropical Medicine and Gastroenterology Department, Assuit University, Assuit Egypt.

⁶ Department of Gastroenterology and Heptology, Maadi Armed Forces Medical Complex, Military Medical Academy,

⁷ Department of internal medicine, Ain shams university, Cairo, Egypt

⁸ Tropical Medicine Department, Alexandria Faculty of Medicine, Alexandria, Egypt

⁹ Alexandria UniversityTropical Medicine Department, Alexandria Faculty of Medicine, Alexandria, Egypt

¹⁰ Tropical medicine and Gastroenterology, Aswan University, Aswan, Egypt

¹¹ Hepatology and gastroenterology department National liver Institute Menofia university

¹² Department of hepatology and gastroenterology Al Farabi Hospital. Oujda. Morocco

¹³ Hepatology, gastroenterology and infectious diseases Department, Al-Azhar University, Cairo, Egypt.

¹⁴ Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.

¹⁵ Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt

¹⁶ Tropical Medicine and Infectious diseases Department, Tanta University, Tanta, Egypt

¹⁷ Department of internal medicine, Al-Azhar University, Cairo 11884, Egypt.

10.21608/gg.2023.203591.1010

Abstract

Purpose: We conducted a systematic review and network meta-analysis (NMA) to estimate the efficacy of Helicobacter pylori (H. pylori) treatment strategies in Arab countries.
Methods: We searched electronic databases from inception to July 18, 2020, using boolean operators. Search terms were (Helicobacter pylori R H. pylori OR pylori OR helicobacter). The risk of bias was assessed using Cochrane risk of bias tool. Retrieved articles were screened, and relevant data were extracted. We used R programming software to analyze extracted data.
Results: Fifty-four articles (n= 7829 patients) were included in the NMA. Pooled analysis demonstrated that adjuvant therapy (standard triple or sequential therapy plus another adjuvant drug) was the best treatment with higher odds of eradication rate [OR= 6.42, 95% CI (1.37: 30.05), P-score= 0.21]. In naïve population, quinolones-based therapy (QBT) and sequential therapy (SQT) were associated with higher eradication rates than other regimens [OR= 1.94, 95% CI (1.19: 3.16), P score=0.19] and [OR= 1.66, 95% CI (1.10: 2.50), P score=0.33]. In experienced population, all medication showed a non-significant difference in eradication rates when compared to triple therapy (TT); QBT (OR= 1.86, 95% CI, [0.15, 22.88], p=0.44) and SQT (OR= 1.49, 95% CI, [0.13, 17.59], p=0.52).
Conclusion: Our findings suggested that QBT and SQT therapies were the most effective regimens for eradicating H. pylori in naïve patients in the Arab countries. In experienced patients, all medication showed a non-significant difference in eradication rates.

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