Bismuth supplements as the first‐line regimen for Helicobacter pylori eradication therapy: Systemic review and meta‐analysis

• Published in: Helicobacter (Cambridge, Mass.) Vol. 24; no. 2; pp. e12565 - n/a
• Main Authors: Ko, Sung Woo, Kim, Yeon‐Ji, Chung, Woo Chul, Lee, Seung Jae
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2019
• Subjects: Antibiotic resistance; Antibiotics; Bismuth; Clarithromycin; Clinical trials; Confidence intervals; Eradication; Helicobacter pylori; Meta-analysis; Patients; Randomization; Side effects; Therapy; Helicobacter pylori; eradication; bismuth
• ISSN: 1083-4389; 1523-5378
• DOI: 10.1111/hel.12565

Background and Aims
An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (H pylori). Consequently, it has been considered that the first‐line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first‐line regimen for H pylori eradication.
Methods
We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta‐analysis of all randomized controlled trials comparing bismuth supplements with non‐bismuth‐containing regimens in H pylori eradication was performed. RCTs of classic bismuth‐containing quadruple therapy as a first‐line regimen were excluded.
Results
We identified twenty‐five randomized trials (3990 patients), and the total H pylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57‐2.13). Among these RCTs, there were 7 RCTs for bismuth add‐on therapy, and the odds ratio was 2.81 (95% CI. 2.03‐3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth‐containing regimens were superior to non‐bismuth regimens. Moreover, the incidence of total side effects was insignificant.
Conclusions
Bismuth supplements as a first‐line regimen could be effective, with bismuth add‐on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin‐resistant strains and would be the most viable alternative in clinical practice.