Helicobacter pylori (Hp) is a bacterium that has been identified as a primary cause of chronic gastritis, peptic ulcer disease, and is associated with the development of gastric cancer. In Turkey, as in many parts of the world, Helicobacter pylori infection presents a significant public health challenge. A recent systematic evaluation and meta-analysis, focusing on the efficacy of the standard triple therapy (STT) in eradicating H. pylori in Turkey, has shed light on the 10-year success rate of this regimen.
The study, published in “The Turkish Journal of Gastroenterology” by Sezgin Orhan et al., analyzed the effectiveness of STT, which entails the use of a proton pump inhibitor (PPI) along with clarithromycin and amoxicillin, in the first-line therapy against H. pylori infection. The research scrutinized data from 45 studies, incorporating a total of 3715 patients over a decade from 2004 to 2013.
Research Findings
The meta-analysis executed as per the PRISMA standards showed an unacceptably low mean eradication rate. Intention-to-treat analysis reported a 60% eradication rate (95% CI: 56%-63%), while the per-protocol analysis reported a 57% rate (95% CI: 51%-62%). Interestingly, the study duration, ranging from 7 to 14 days, and the types of PPIs used did not significantly influence the outcomes. Notably, the eradication rate for the 10-day treatment duration was higher at 78% (95% CI: 66%-86%), though based on only one study.
The meta-regression analysis accounted for factors, such as treatment duration, PPI, age, and gender ratio, which appeared to have no significant effect on the eradication rates.
Implications of the Study
This research carries significant implications for clinical practice. The striking takeaway is the low efficacy of the STT for H. pylori eradication in Turkey. This signals a pressing need for the revision of current treatment guidelines and the exploration of alternative therapies.
The lack of influence of treatment duration on the success rate also raises an important subject for further inquiry. The viability of STT, when other factors such as PPI type, gender, and age also show negligible impact, comes into question.
It is noteworthy to mention that Turkey maintains its place with concerning high rates of antibiotic resistance, partly explaining the dismal performance of STT. Indeed, prior studies have indicated that resistance to clarithromycin, a key component of the therapy, is considerably on the rise.
Recommendations for Clinical Practice
Given the low eradication rates reported by the 10-year systematic evaluation and meta-analysis, the authors suggest that alternative treatment strategies be devised and applied for the management of H. pylori infection in Turkey. This may include quadruple therapy or sequential therapy, which has shown promise in countries grappling with similar antibiotic resistance issues.
The authors also recommend regular updating of national guidelines based on current data on antibiotic resistance patterns and the outcomes of H. pylori treatment regimens.
Limitations and Further Research
The meta-analysis is not without limitations. It covered studies that were heterogeneous in nature and incorporated data over a span of a decade, during which treatment strategies and resistance patterns may have evolved. Additionally, the high variability in the regimens and the small number of studies for specific treatment durations (e.g., 10 days) could have impacted the findings’ reliability.
Further research is warranted to elucidate the causes behind the low efficacy rates. Studies exploring the impact of different doses and combinations of antibiotics and PPIs, along with the inclusion of other agents such as bismuth or probiotics, could potentially lead to the development of more effective treatment strategies.
Conclusion
The systematic compilation and meta-analysis conducted by Orhan et al. deliver critical insights into the efficacy of STT for H. pylori eradication in Turkey. The findings highlight an urgent need for revising treatment approaches and inform health professionals regarding the inefficacy of the STT, promoting the persual of more effective first-line therapies.
Considering the study’s revelations, healthcare providers in Turkey and similar settings should be circumspect about relying on STT and stay abreast with advancements in H. pylori treatment guidelines.
Overall, this research represents an important step toward improving the management of H. pylori infections in Turkey, aiming to reduce the burden of associated diseases for future generations.
References
1. Makola D, Peura DA, Crowe SE. Helicobacter pylori infection and related gastrointestinal diseases. J Clin Gastroenterol. 2007;41:548–58.
2. Franceschi F, Gasbarrini A. Helicobacter pylori and extragastric diseases. Best Pract Res Clin Gastroenterol. 2007;21:325–34.
3. Roubaud-Baudron C, Krolak-Salmon P, Quadrio I, Mégraud F, Salles N. Impact of chronic Helicobacter pylori infection on Alzheimer’s disease: preliminary results. Neurobiol Aging. 2012;33:1009.e11–1009.e19.
4. Venerito M, Selgrad M, Malfertheiner P. Helicobacter pylori: gastric cancer and extra gastric malignancies – clinical aspects. Helicobacter. 2013;18(Suppl 1):39–43.
5. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection Report. Gut. 2007;56:772–81.
Keywords
1. Helicobacter pylori eradication Turkey
2. Standard triple therapy H. pylori
3. Proton pump inhibitors H. pylori
4. Clarithromycin resistance Turkey
5. H. pylori treatment outcomes