Publication Date
3-1-2022
Journal
Gut
DOI
10.1136/gutjnl-2021-326170
PMID
34750206
PMCID
PMC8828664
PubMedCentral® Posted Date
3-1-2022
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
Anti-Bacterial Agents, Helicobacter Infections, Helicobacter pylori, Humans, Network Meta-Analysis, Helicobacter pylori; treatment; antimicrobial therapy, cure rates; randomized control trial; meta-analysis; network meta-analysis; heterogeneity; strawman comparisons
Abstract
Helicobacter pylori infections are responsible for tremendous morbidity and mortality worldwide, leading to efforts to eradicate the organism. However, the effectiveness of antimicrobial therapy has been undermined by the progressive development of antimicrobial resistance. Treatments and treatment guidelines have been based on traditional pairwise meta-analyses of randomized controlled trials. More recently, network meta-analyses have also been utilized in an attempt to provide useful information to the clinician regarding which therapies appear best and which to avoid as the least efficacious. However, both forms of meta-analysis have been undermined by the same problems including the poor quality of the clinical trials using unoptimized regimens and incomparable comparisons related to marked geographic and ethnic genotypic and phenotypic heterogeneity. In addition, the comparator regimens often consist of invalid strawman comparisons. New approaches concerning H. pylori treatment and analysis of therapies are needed. H. pylori therapies should be based on antimicrobial stewardship, as in other infectious diseases. This approach requires the use of only optimized therapies proven to be reliably highly effective in the local population (e.g., a cure rate of ≥90%) for both the study and the comparator regimens. Meta-analyses should be restricted to regimens that meet these criteria and must take into account the presence of marked geographic and host genetic and phenotypic heterogeneity. In addition, to provide clinically relevant results, treatment outcomes should focus on, and present, actual cure rates in addition to odd ratios.
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