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The Efficacy and Safety of Bismuth-Based Quadruple Therapy for Helicobacter Pylori Infection: A Meta-Analysis

Yongping Zhang, Yifeng Zhou, Qi Zhang, Xiaofeng Zhang and Qiang Cai

Objective: To assess the safety and efficacy of bismuth-based quadruple therapy for Helicobacter pylori (H. pylori) infection. Methods: We searched the PubMed, Cochrane and EMBASE databases updated to January 2015 for randomized controlled trials (RCTs) comparing bismuth-based quadruple therapy (Bismuth quadruple therapy) with non-bismuth standard triple therapy (standard therapy) for H. pylori infection. Literature qualities were assessed using Cochrane assessment system. Meta-analysis was carried out with Stata 11.0 and Review Manager 5.3. Risk ratio (RR) and their 95% confidence interval (95% CI) were computed. Subgroup analysis and sensitivity analysis were performed. Egger’s test was performed to evaluate publication bias among studies. Results: Ten RCTs were eligible and enrolled. In the overall analysis, bismuth quadruple therapy achieved comparable intention-to-treat cure rates (RR = 0.90, 95% CI: 0.62~1.30, P = 0.57), per-protocol cure rates (RR = 1.29, 95% CI: 0.54~3.09, P = 0.57), and recrudescence rates (RR = 0.98, 95% CI: 0.49~1.98, P = 0.96) to the standard triple therapy. Side-effects were also similar between those two therapies (RR = 0.91, 95% CI: 0.73~1.13, P = 0.40). Moreover, subgroup analysis indicated bismuth quadruple therapy had significantly higher intention-totreat cure rates (RR = 0.72, 95% CI: 0.55~0.93, P = 0.01), but comparable per-protocol cure rates (RR = 0.71, 95% CI: 0.49~1.04, P = 0.08) and side-effects (RR = 0.97, 95% CI: 0.76~1.23, P = 0.79) to the standard triple therapy. Conclusions: Bismuth quadruple therapy had similar safety to the standard triple therapy, whereas it was more effective than standard triple therapy in the treatment of H. pylori infection.