Meta‐analysis: proton pump inhibitor or H2‐receptor antagonist for Helicobacter pylori eradication

Abstract

SummaryAim : To compare H2‐receptor antagonists and proton pump inhibitors as adjuvants to triple therapy for Helicobacter pylori eradication.Methods : H. pylori‐infected patients with peptic ulcer were randomized to receive either 300 mg nizatidine or 30 mg lansoprazole plus 1 g amoxicillin and 500 mg clarithromycin taken b.d. for 7 days. H. pylori eradication was assessed 4 weeks after therapy. Using meta‐analytical techniques, we combined the results of this study with other randomized controlled comparisons of H2‐receptor antagonists and proton pump inhibitors as adjuvants to triple therapy.Results : One hundred and one patients were randomized. H. pylori eradication was 94% (47/50) [95% confidence interval (CI), 83–99%] (intention‐to‐treat) in the H2‐receptor antagonist group vs. 86% (44/51) (95% CI, 74–94%) in the proton pump inhibitor group (P = 0.3). There has been a total of 12 similar studies (1415 patients). The overall efficacy was similar in intention‐to‐treat analysis: 78% (549/701) with H2‐receptor antagonists vs. 81% (575/714) with proton pump inhibitors (odds ratio, 0.86; 95% CI, 0.66–1.12). A non‐significant trend favouring H2‐receptor antagonist (79% vs. 69%; odds ratio, 1.14; 95% CI, 0.76–1.71; P = 0.5) was seen in the comparison of clarithromycin‐containing regimens. In contrast, in non‐clarithromycin‐containing trials, there was a slight, but significant, advantage with proton pump inhibitors (85% vs. 78%; odds ratio, 0.64; 95% CI, 0.45–0.92; P = 0.02).Conclusion : Overall, proton pump inhibitor andH2‐receptor antagonist antisecretory agents appear to be similarly effective as adjuvants for H. pylori triple therapy. It is unlikely that the direct anti‐H. pylori effect of proton pump inhibitors is responsible for their ability to enhance anti‐H. pylori therapy.