Berberine Combined with Triple Therapy versus Triple Therapy for Helicobacter pylori Eradication: A Meta-Analysis of Randomized Controlled Trials

Abstract

Objective To assess the effects and safety of berberine combined with triple therapy on Helicobacter pylori (H. pylori) eradication in adults. Methods PubMed, MEDLINE, EMBASE, Cochrane Library, and Chinese databases including China National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Technology Journal Full-text Database (VIP), and China biomedical literature database (CBM) were searched to obtain the eligible studies published up to October 10, 2017. The primary outcome was eradication rate of H. pylori. The secondary outcome was incidence of adverse effects. Data analysis was conducted by RevMan5.2 and Stata V.9.0 software. Trial sequential analysis (TSA) was performed to assess the risk of random error and the validity of conclusion with TSA program version 0.9 beta. Results The meta-analysis results indicated berberine combined with triple therapy could improve the eradication rates of H. pylori (urea breath test subgroup: RR=1.18, 95%CI=(1.12,1.24), P < 0.00001, biopsy subgroup: RR=1.23, 95%CI=(1.13,1.34), P < 0.00001) and reduce the total occurrence of adverse effects (OR=0.59, 95%CI(0.46, 0.75), P < 0.0001) when compared with only using triple therapy. Besides, the incidence of nausea (OR=0.59, 95%CI(0.41, 0.86), P < 0.05) and diarrhea (OR=0.41, 95%CI(0.24, 0.71) was remarkably lower in experimental group while that of abdominal distention (OR=0.64, 95%CI(0.40,1.04), P > 0.05) and vomiting (OR=0.65, 95%CI(0.37, 1.15), P > 0.05) had no significant change. TSA of H. pylori eradication rates and adverse effects incidence illustrated that the cumulative value of Z-curve went across the conventional boundary value, trial sequential monitoring boundary for benefit, and required information size, suggesting the results were stable. Conclusion Evidence from meta-analysis suggested that berberine combined with triple therapy can be an option for increasing H. pylori eradication rates and reducing overall therapy-related adverse effects incidence, particularly nausea and diarrhea, whereas more randomized controlled trials designed according to CONSORT statement are demanded to support the efficacy in further studies.

Optimized Centrifugal Partition Chromatography (CPC) Protocol for Isolation of Urease Inhibitors: Magnoflorine and Berberine from Berberis vulgaris Extracts

“…Previously, berberine was recognized as a compound with activity against Helicobacter pylori [40]. Evidence from a clinical trial suggests that berberine combined with standard therapy can be an option to eradicate H. pylori [41,42]. On the other hand, the inhibition of urease is another parameter that can predict the potential behavior of a metabolite against H. pylori.…”

Diagnosis and treatment ofHelicobacter pyloriinfections in children and elderly populations

“…Several lines of evidence from a meta-analysis indicated that berberine in combination with triple therapy increased H. pylori eradication rates and also reduced the overall incidence of therapy-related adverse effects. 68 Additionally, a randomized, non-inferior trial conducted in China demonstrated that a berberine-quadruple regimen (PPI, amoxicillin, clarithromycin, and berberine) was comparable to the bismuth-containing quadruple regimen (PPI, amoxicillin, clarithromycin, bismuth). 69 Additional studies are crucial to define the role of berberine in H. pylori eradication.…”

In Vitro Anti-Helicobacter pylori Activity of Berberine and Barberry Extracts: A Preliminary Report

“…4 Berberine combined with triple therapy can be an option for increasing H. pylori eradication rates and reducing overall the incidence of therapy-related adverse effects. 5 The aim of this research was to investigate berberine accumulation in B. vulgaris and anti-H. pylori activity of barberry extracts obtained from wild and cultivated plant populations. The antibacterial activities of berberine and the standard antimicrobials metronidazole and tetracycline were also determined.…”

“…4 Berberine combined with triple therapy can be an option for increasing H. pylori eradication rates and reducing overall the incidence of therapy-related adverse effects. 5…”