Role and Importance of Microbiology Testing in the Diagnosis and Treatment of Helicobacter Pylori Infection

Stamboliyska, Miglena; Kaludova, Violina; Mirchev, Milko; Kotzev, Iskren; Madjov, Rossen; Metodiev, Krasimir

doi:10.5272/jimab.2015214.969

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“…The different steps in the selection of studies and the reasons for the exclusion of studies [non-comparative (Gasbarrini et al, 2000 ; Gomollon et al, 2000 ; Chi et al, 2003 ; Cammarota et al, 2004 ; Fiorini et al, 2013 ; Liou et al, 2013 ; Choi et al, 2014 ; Sugimoto et al, 2014 ; Draeger et al, 2015 ; Stamboliyska et al, 2015 ; Han et al, 2016 ; Cosme et al, 2017 , 2019 ; Costa et al, 2017 ; Králícek et al, 2017 ; Blümel et al, 2018 ; Kwon et al, 2019 ; Lee et al, 2019 ; Yu et al, 2019 ; Zhu and Wu, 2019 ) and cost-effectiveness (Breuer and Graham, 1999 ; Qasim et al, 2004 ; Faber et al, 2005 ; Cammarota et al, 2014 )] are reported in the PRISMA flow chart ( Figure 1 ).…”

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Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

2022

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BackgroundTreating Helicobacter pylori infection according to antibiotic resistance has been frequently recommended. However, information on its real effectiveness is scarce.AimThe aim of this study is to perform a meta-analysis comparing empirical vs. susceptibility-guided treatment of H. pylori.MethodsSelection of studies: Studies comparing empirical versus susceptibility-guided treatment were selected. Search strategy: electronic and manual up to August 2021. Data synthesis: by intention-to-treat (random-effects model).ResultsOverall, 54 studies were included (6,705 patients in the susceptibility-guided group and 7,895 in the empirical group). H. pylori eradication rate was 86 vs. 76%, respectively (RR: 1.12; 95% CI: 1.08–1.17; I2: 83%). Similar results were found when only RCTs were evaluated (24 studies; RR: 1.16; 95% CI: 1.11–1.22; I2: 71%) and when susceptibility testing was assessed by culture (RR: 1.12; 95% CI: 1.06–1.18) or PCR (RR: 1.14; 95% CI: 1.05–1.23). For first-line treatments (naïve patients; 30 studies), better efficacy results were obtained with the susceptibility-guided strategy (RR: 1.15; 95% CI: 1.11–1.20; I2: 79%). However, for empirical first-line quadruple regimens, in particular (both with and without bismuth, excluding the suboptimal triple therapies), not based on CYP2C19 gene polymorphism, no differences in efficacy were found compared with the susceptibility-guided group (RR: 1.04; 95% CI: 0.99–1.09); this lack of difference was confirmed in RCTs (RR: 1.05; 95% CI: 0.99–1.12). For rescue therapies (13 studies, most 2nd-line), similar results were demonstrated for both strategies, including all studies (RR: 1.09; 95% CI: 0.97–1.22; I2: 82%) and when only RCTs were considered (RR: 1.15; 95% CI: 0.97–1.36).ConclusionThe benefit of susceptibility-guided treatment over empirical treatment of H. pylori infection could not be demonstrated, either in first-line (if the most updated quadruple regimens are prescribed) or in rescue therapies.

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