Helicobacter pylori eradication therapy in The Netherlands

Helicobacter pylori cure rates vary in different geographical regions because of differences in hosts as well as in H. pylori strains.

To review systematically all available data in the literature to determine H. pylori eradication rates in The Netherlands.

A search of all published trials on H. pylori eradication therapy performed in The Netherlands was conducted via electronic database search, hand-searching of abstracts from scientific meetings and checking reference lists of pharmaceutical companies. Full papers and abstracts were included. Data on anti-H. pylori therapies were pooled based on duration and combination of drugs. Only triple and quadruple eradication regimens were studied. Dual therapies were excluded, except for ranitidine bismuth citrate-based dual therapies.

We analysed 38 study arms, involving 2197 patients. Twenty different pooled regimens were studied with a mean intention-to-treat eradication rate of 83% (range 35-96%). There were no significant differences in the percentage of patients that stopped treatment due to adverse events between the groups. In these pooled regimens only bismuth combined with tetracycline and metronidazole for 1 or 2 weeks was significantly lower in efficacy in metronidazole-resistant strains than in metronidazole-sensitive strains. The prevalence of metronidazole-resistant strains in The Netherlands showed large regional differences (7-50%).

A therapy should be tested in a defined population before becoming standard. Several eradication regimens studied in The Netherlands yield acceptable cure rates of 80% or more on an intention-to-treat basis. We advise taking the local prevalence of metronidazole resistance into account when choosing a first-line eradication regimen.