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Related Experiment Video

Updated: Jul 2, 2025

Author Spotlight: Detection and Treatment of Helicobacter pylori Infection
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Sequential versus Standard Triple Therapy for First-Line Helicobacter pylori Eradication: An Update.

Olga P Nyssen1, Belén Martínez1, Francis Mégraud2

  • 1Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain.

Antibiotics (Basel, Switzerland)
|February 23, 2024
PubMed
Summary

Non-bismuth sequential therapy (SEQ) showed higher efficacy than standard triple therapy (STT) for H. pylori eradication before 2010. Neither therapy is optimal for first-line treatment.

Keywords:
H. pyloriantibiotic resistanceclarithromycineradication therapyfirst-line therapymeta-analysissequential therapystandard triple therapysystematic review

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Pharmacology

Background:

  • Non-bismuth sequential therapy (SEQ) proposed as an alternative to standard triple therapy (STT) for H. pylori.
  • Evaluating SEQ and STT efficacy is crucial for optimizing H. pylori eradication strategies.

Purpose of the Study:

  • To compare the efficacy of 10-day SEQ versus STT (≥7 days) as a first-line H. pylori treatment.
  • To analyze eradication rates and risk differences through a systematic review and meta-analysis.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) up to July 2021.
  • Included treatment-naïve adult and pediatric patients.
  • Calculated intention-to-treat (ITT) eradication rates and risk difference (RD).

Main Results:

  • 69 RCTs involving 19,657 patients compared SEQ and STT.
  • SEQ demonstrated significantly higher overall efficacy (82% vs. 75%; RD 0.08; p < 0.001).
  • High heterogeneity observed (I² = 68%); subgroup analyses indicated benefits of SEQ in clarithromycin-resistant cases and specific regions.

Conclusions:

  • SEQ was more effective than STT before 2010, especially with 7-day STT.
  • A trend towards reduced differences between therapies noted with longer STT durations (10 days) and post-2010.
  • Neither therapy achieved optimal efficacy, precluding recommendation as a first-line H. pylori treatment.